There are a variety of treatment options available for the support of Obstructive Sleep Apnea (OSA). The interpreting sleep physician will make a recommendation of the preferred treatment choice based on the severity of the condition, the potential for quality of life improvement and the patient’s acceptance of therapy.
A. CPAP (Continuous Positive Airway Pressure)
- Treatment of choice.
- 95% effective.
- 60-70% compliance.
- Effective in both OSA and Central Sleep Apnea.
- Funding assistance available through the Ontario Ministry of Health and Long Term Care for eligible applicants.
- Private health plans very commonly also supplement the cost of therapy.
B. Oral Appliances (Mandibular Advancement Devices)
- Numerous styles.
- Effective in 70% of cases.
- Best made by an experienced dentist with expertise in dental sleep medicine.
- Teeth shift can occur over the long term.
- Should not be used in patients with pre-existing temporal-mandibular joint disease.
C. Surgery (most have limited/no long term follow up data except UPPP and tracheostomy)
- Nasal reconstruction.
- Uvulopalatopharngoplasty (UPPP) – 50% of cases improved.
- Laser assisted uvuloplasty (LAUP).
- Radiofrequency therapy (RFA).
- Palatal implants.
- Maxillary mandibular advancement (MMA).
D. Weight Reduction
- Relatively new therapy that has undergone limited short term evaluation.
- May be useful in mild-moderate sleep apnea.
- Not proven to adequately correct severe sleep apnea.
- Unlike other treatments there are no upfront costs, however, it requires ongoing expenditures to use this form of therapy.
- Retesting with therapy is important, to ensure that the treatment is effective.
F. Medication (very limited role)
- Hormone replacement therapy.
- Mirtazapine (Remeron).
- Nasal decongestants.