If you already suffer from sleep apnoea, or think that you or your partner may have this dangerous problem, and it remains undiagnosed for whatever reason, then the new rules that have been issued in the United States will have some real meaning for you.
The American College of Physicians (ACP) has published new clinical practice guidelines regarding the management and treatment of OSA in adults. It deals with the known detrimental effects of the problem, and discusses the limitations of the various available treatments. These findings endorse those of the AASM – the American Academy of Sleep Medicine but take recommendations further.
As ever, the USA is ahead of the UK in dealing with this huge problem, partly because it is so much more widespread in the community there. Much of this can be linked to obesity, a major problem in the USA, and which is rapidly becoming so here due to changes in our diet, lower exercise levels in youth, and sedentary occupations now being the largest group by far versus manual workers. Alcohol also often plays a significant role in the equation – mostly due to the high calorific intake and the effect that alcohol can have on sleep hygiene.
What is OSA?
OSA disrupts breathing during sleep, and this is usually as a result of the muscles and soft tissues in the throat relaxing and collapsing to block the airway. It can last for about 10 seconds or even more. It affects people of all ages, but particularly those of us in middle age, and particularly the elderly.
However, we believe that around 80% of cases remain undiagnosed. OSA is easy to treat but when left undiagnosed and untreated, is linked with a range of serious health concerns that include heart disease and stroke, diabetes and high blood pressure, called hypertension. Fatigue becomes a huge problem too.
Current approved treatments for OSA and sleep disordered breathing
OSA is a chronic medical disorder that requires immediate action, but also requires long term, and often lifelong. therapy. Obviously a healthier lifestyle will come high on the list from any GP but this will not stop the problem of your snoring immediately, and sometimes does not succeed at all.
As well as recommending weight loss in overweight and obese patients, it recommends and approves the following treatments as it is recognised that weight-loss intervention alone will not achieve the desired objectives.
Medical Treatments and Clinical Recommendations for OSA
- Continuous Positive Airway Pressure (CPAP) is recommended for more serious sufferers but it is readily identified that many patients reject this treatment for various reasons, particularly having to wear a mask for such long periods of time, claustrophobia, having a dry mouth, or the associated discomfort of the mask amongst others.
- It is still however strongly recommended for chronic sufferers if acceptable.
- Mandibular Advancement Devices (MAD’s or Splints) are fully recommended as a primary treatment route and a strong option in many cases versus CPAP. They are more readily accepted than masks and have many distinct advantages over them including, ease of wear, instant results, high rates of effectiveness and also being inexpensive by comparison – even bespoke mouthpieces or the now available self-fit versions which are highly adjustable compared to the standard oral appliance – although this may be the best starting point.
- Strongly recommended by ACP for less severe versions of OSA.
- Surgery however is not listed in the ACP’s summarized recommendations, but the guideline does specifically discuss its role as a treatment for OSA. It highlights that surgical procedures, which are intended for sleep-disordered breathing, are not as effective as either CPAP or using MAD’s. Currently success rates vary greatly and can be as low as 20%, as well as it sometimes requiring several procedures.
- Not currently recommended by ACP to American Physicians.
More and more clinics, doctors and hospitals in the USA now recommend using oral appliance technology in the form of a mouthpiece to be used when sleeping and this is now becoming more accepted as a route here in the UK, particularly now that higher quality MAD’s are NHS Approved.
By John Redfern