Alternatives to positive airway pressure for obstructive sleep apnea syndrome

Abstract

Owing to the prevalence, the considerable risk of accidents and cardiovascular consequences, optimal treatment of obstructive sleep apnea syndrome is of crucial importance. However, many patients look for alternative conservative or surgical therapies to continuous positive airway pressure to avoid discomfort and local side-effects owing to the mask. Scientific data are lacking for most of the alternative methods. However, it has been proven that intra-oral appliances can reduce mild-to-moderate respiratory disturbances; the maxillo-mandibular osteotomy is efficient in the short- and long-term but is preferred in special situations such as craniofacial dysmorphias. Weight reduction and body positioning cannot be recommended as a single treatment for obstructive sleep apnea syndrome. Resections of muscular tissue within the soft palate have to be strictly avoided. Efficacy of gentle soft palate procedures is difficult to predict and often decreases in the years following this treatment. Multilevel surgery concepts are of increasing interest, although more data from prospective, controlled studies are needed.

Keywords::

• continuous positive airway pressure
• mandibular advancement device
• maxillo-mandibular osteotomy
• multilevel surgery
• obstructive sleep apnea syndrome
• positional treatment
• radiofrequency surgery
• tongue muscle stimulation
• uvulopalatopharyngoplasty
• weight reduction

Financial & competing interests disclosure

Winfried J Randerath has receieved scientific grants, talk fees and travel grants from the companies Respironics, Weinmann and ResMed. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.