In summary, while significant weight loss can lead to improvements in OSA, the data demonstrate that the majority of patients do not achieve or maintain enough weight loss to resolve their sleep disordered breathing and thus will require ongoing treatment for the OSA. Given these data, weight loss should not be considered a primary therapy for moderate to severe OSA and should be recommended as a secondary therapy or intervention that supplements a primary treatment such as CPAP or oral appliances.
Despite the highly effective treatment CPAP offers, poor adherence limits its efficacy. Compliance has been variably classified in the literature and thus adherence rates range from quarenta–85% (1,15). In the US, compliance has been arbitrarily defined as usage for more than 4 hours per night for more than 70% of nights. Of course, this does not correlate to a specific threshold beyond which efficacy is absolute—in short, the greater the use of CPAP, the better the outcomes in terms of symptomatic quality of life markers and longer term blood pressure/cardiovascular readings. Hence, there has been great interest in improving tolerability of the CPAP system. Commonly cited side effects include dermatitis, rhinitis, epistaxis, nasal discomfort, congestion, mask leak, aerophagia, barotrauma and claustrophobia. There may therefore be specific otolaryngological factors contributing to failure of CPAP, particularly in relation to the nasal cavity and paranasal sinuses. Contributing nasal conditions include anatomical, physiological and pathological factors. Anatomical considerations incorporate deviated nasal septum (DNS), external framework deformities, valve collapse, enlarged turbinates and nasopharyngeal pathology occluding the posterior choanae (e.
Clinical studies have demonstrated that Inspire sleep apnea treatment is safe, though all surgeries carry risks. Incidents of serious complications related to the surgical procedure were less than 2%. In rare cases, extreme discomfort may require another operation to reposition the device.
Weight: People with a BMI of 32 or higher may not be ideal candidates for Inspire sleep apnea treatment due to the effect obesity can have in reducing the effectiveness of upper airway stimulation.
Talk to Your Doctor About an APAP Machine: If your CPAP aerophagia is bad enough to make you consider quitting CPAP therapy, it may be time to talk to your healthcare provider about switching to an APAP machine, which delivers the lowest air pressure possible to still keep your airway open.
Further, even for those patients who are able to lose a significant amount of weight and maintain that weight loss over time, a follow up sleep study should be performed to assess for residual disease prior to discontinuing CPAP therapy.
This makes your airways narrow and collapse, and you stop breathing for a moment, until your brain wakes you up to begin breathing again. Read more about obstructive sleep apnoea(external link).
Upper airway surgery can be considered for patients who cannot tolerate CPAP or oral appliance therapy. Current data evaluating various procedures are limited and more information is required to determine which procedures may benefit certain here patient groups.
Consider a Different Mask: Switching to a different mask style may help you breathe a little easier, making you less likely to swallow air.
According to most health experts, Continuous Positive Airway Pressure (CPAP) therapy is considered the most effective way to minimize the effects and reduce health risks associated with sleep apnea.
Rigid endoscope image of nasal polyposis (NP); note the differing texture, colour and position of the polyp in comparison to the normal nasal mucosa; polyps are also insensate.
pressure. The pressure stays the same while the patient breathes in and out. It does not change unless the clinician increases or decreases the set pressure.
1 "We believe this unprecedented decision by the FDA will generate broader acceptance throughout the medical community for Vivos treatment options, leading to the potential for higher patient referrals and case starts as well as collaboration with medical professionals.”
Base of tongue collapse is recognized as a significant site of obstruction in patients with OSA and is often underappreciated. There may also be an associated epiglottic contribution (64). Both of these will significantly increase CPAP pressure requirement and hence cause difficulty in tolerating this form of therapy.