Treatments for Adult Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a chronic sleep disorder that requires a long-term multidisciplinary approach. OSA is characterized by repetitive upper airway collapses during sleep, resulting in various symptoms and outcomes. Therefore, accurate diagnosis and appropriate treatment are needed. In general, positive airway pressure (PAP), oral appliance (OA), and surgery are considered as the primary therapeutic methods, and weight loss and positional therapy are additional or adjunctive treatment options. PAP is recommended for the standard treatment of moderate-to-severe OSA [apnea-hypopnea index (AHI) ≥ 15] and is the optional treatment for mild OSA (5 ≤ AHI < 15). OA is indicated in mild-to-moderate OSA (5 ≤ AHI < 30) that favors OA over PAP. Surgical treatment is usually recommended for patients who manifest anatomical defects that can be alleviated surgically or show a high degree of surgical success rate. Surgery is also indicated in cases refractory to or contraindicated for medical treatments such as PAP and OA. In addition, surgical therapy may be performed as adjunct treatments along with other therapies. Diverse therapeutic options including the indications, mechanisms of action, clinical effects, and limitations should be discussed with the patient during the counseling sessions. Furthermore, the patients should actively participate in the treatment of their own disorder. In summary, an individualized therapeutic method should be considered based on a comprehensive analysis of the patient’s physical findings, such as upper airway anatomy, and obesity, results of polysomnography, such as AHI, respiratory disturbance index, and minimum oxygen saturation, in addition to therapeutic preferences and expectations