Management of Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) is an important public health problem and is associated<br />with considerable morbidity and mortality. Therefore, treatment of this condition is of<br />paramount importance. The treatment of OSA includes general and behavioural<br />measures, mechanical measures including continuous positive airway pressure<br />(CPAP), Bilevel positive airway pressure (BiPAP) and Oral Appliances (OA),<br />pharmacological treatment and surgical procedures. Continuous positive airway<br />pressure (CPAP) treatment reverses the repetitive upper airway obstruction of sleep<br />apnea and associated daytime sleepiness and is the most effective treatment for OSA.<br />However maintaining patient adherence to CPAP therapy is a challenge. Weight loss<br />should be recommended to overweight patients with OSA, as it has been shown that<br />weight reduction has additional health benefits. Treatment of underlying medical<br />conditions such as hypothyroidism or acromegaly has profound effect on<br />apnea/hypopnea index. A subset of patients with OSA may benefit from supplemental<br />oxygen and positional therapy. Presently, there are no effective pharmacotherapeutic<br />agents for treatment of patients with OSA and the role of surgical treatment in OSA is<br />controversial. However, pharmacological treatment of persisting residual sleepiness,<br />despite adequate positive airway pressure therapy delivery and adherence, is indicated<br />and may improve daytime sleepiness.<br />Key words : CPAP, Oral appliances, Modafinil, CPAP compliance<br />Uvulopalatopharyngoplasty, positional therap