The objective of treatment is to keep the airway open to prevent apneic episodes during sleep. The specific therapy for sleep apnea is tailored to the individual patient based on medical history, physical examination, and the results of polysomnography. Medications are generally not effective. Oxygen administration may safely benefit certain patients but does not eliminate sleep apnea or prevent daytime sleepiness. Thus, the role of oxygen in the treatment of sleep apnea is controversial, and it is difficult to predict which patients will respond well. It is important that the effectiveness of the selected treatment be verified; this is usually accomplished by polysomnography.
For mild cases of obstructive sleep apnea, treatment often consists of using methods to avoid sleeping on one's back. For people with significant nasal congestion, a decongestant therapy may be prescribed. Patients with obstructive and central apnea should avoid central nervous system depressants such as alcoholic beverages, sedatives and narcotics. Weight loss and diet control are encouraged for overweight patients. Many serious cases of obstructive sleep apnea can be relieved by a treatment called nasal continuous positive airway pressure (nasal CPAP). Nasal CPAP uses a mask-like device and pump that work together to keep the airway open with air pressure during each inspiration. Surgery may benefit some patients by eliminating or reducing the narrowing of the airway due to anatomical defects.
Behavioral Therapy
Behavioral changes are an important part of the treatment program, and in mild cases behavioral therapy may be all that is needed. The individual should avoid the use of alcohol, tobacco, and sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods. Overweight persons can benefit from losing weight. Even a 10 percent weight loss can reduce the number of apneic events for most patients. In some patients with mild sleep apnea, breathing pauses occur only when they sleep on their backs. In such cases, using pillows and other devices that help them sleep in a side position is often helpful.
Physical or Mechanical Therapy Surgery
Some patients with sleep apnea may need surgery. Although several surgical procedures are used to increase the size of the airway, none of them is completely successful or without risks. More than one procedure may need to be tried before the patient realizes any benefits.
Some of the more common procedures include removal of adenoids and tonsils (especially in children), nasal polyps or other growths or tissue in the airway, and correction of structural deformities. Younger patients seem to benefit from these surgical procedures more than older patients.
Uvulopalatopharyngoplasty (UPPP) is a procedure used to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate). The success of this technique may range from 30 to 50 percent. The long-term side effects and benefits are not known, and it is difficult to predict which patients will do well with this procedure.
Laser-assisted uvulopalatoplasty (LAUP) is done to eliminate snoring but has not been shown to be effective in treating sleep apnea. This procedure involves using a laser device to eliminate tissue in the back of the throat. Like UPPP, LAUP may decrease or eliminate snoring but not sleep apnea itself. Elimination of snoring, the primary symptom of sleep apnea, without influencing the condition may carry the risk of delaying the diagnosis and possible treatment of sleep apnea in patients who elect LAUP. To identify possible underlying sleep apnea, sleep studies are usually required before LAUP is performed.
Tracheostomy is used in persons with severe, life-threatening sleep apnea. In this procedure, a small hole is made in the windpipe and a tube is inserted into the opening. This tube stays closed during waking hours, and the person breathes and speaks normally. It is opened for sleep so that air flows directly into the lungs, bypassing any upper airway obstruction. Although this procedure is highly effective, it is an extreme measure that is poorly tolerated by patients and rarely used.
Patients with deformities of the lower jaw may benefit from surgical reconstruction. Finally, surgical procedures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese.
What is the prognosis?
Eliminating the obstruction usually reverses the commonly associated pulmonary and systemic hypertension and cardiac problems of obstructive apnea. Untreated, sleep apnea can greatly affect daytime functioning. Sleep apnea sufferers have a tendency to fall asleep during the day, a potentially deadly consequence of the disorder.
What research is being done?
Sleep apnea is currently one of the most active areas of sleep research. The National Institute of Neurological Disorders and Stroke has notified investigators that it is seeking grant applications in both clinical and basic sleep and wakefulness research, including neurological causes and consequences of sleep apnea. Research on sleep apnea is also funded by the National Heart, Lung, and Blood Institute and the National Institute on Aging.
Sleep Apnea. Last reviewed 11/07/2006
Sources:
- American Psychiatric Association—Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised
- National Heart, Lung, and Blood Institute, National Institutes of Health
- National Institute of Neurological Disorders and Stroke, National Institutes of Health
- National Sleep Foundation
- National Institutes of Health—National Library of Medicine
