Diagnostics and therapeutic options in obstructive and central sleep apnea syndrome

Obstructive and Central Sleep Apnea are two common and related disorders, greatly affecting daytime energy and concentration, quality of life and health. Several aspects were investigated in the thesis ‘diagnostic and therapeutic options in obstructive and central sleep apnea syndrome’ leading to the following main conclusions:1) When assessing the two most prescribed treatment options for patients with moderate obstructive sleep apnea, continuous positive airway pressure (which prevents upper airway collapse by blowing pressurized air into the upper airway) is more cost-effective in reducing the number of apneas and hypopneas than a mandibular advancement device (oral appliances that advance the mandible in a forward position, thereby increasing upper airway lumen/dimensions). On the other hand, a mandibular advancement device has a more pronounced positive effect in terms of quality-adjusted-life-years, which is a generic measure of disease burden, a weighted combination of the quality and the quantity of life lived. Furthermore, both treatment options showed comparable compliance rates even during the year after. 2) Hybrid therapy, a combination of both mentioned therapies, looks to be an effective alternative treatment option in a selected group of OSA-patients. 3) Positional therapy, using e.g. tennis ball technique to prevent patients from lying on their back during sleep, improves the sleep apnea. However, long-term compliance was low, due to the high discontinuation rate. 4) The ApneaLink, a two-channel screening tool, is useful in excluding sleep apnea in heart failure patients, thereby restricting referral exclusively to high-risk patients and resulting in potential cost savings, as the excluded patients do not need to undergo full blown polysomnographic measurements