Rapid Rx Quiz: Sleep Apnea Devices
CPAP (continuous positive airway pressure), along with other devices such as APAP (automatic positive airway pressure) and BiPAP (bilevel positive airway pressure), have been the mainstay in treating obstructive sleep apnea (OSA) for decades. Despite their proven effectiveness, patients can struggle with discomfort or intolerance of these treatments, which can lead to suboptimal adherence. As a result, alternative devices have been developed to address the needs of individuals who cannot tolerate traditional therapy, offering other approaches to maintaining airway patency and managing related health outcomes.
What do you know about devices for sleep apnea? Test yourself with this brief quiz.
Current clinical practice guidelines from the AASM recommend the use of either APAP or CPAP in OSA treatment in adults. No clinically meaningful differences were found in outcomes of APAP treatment vs CPAP treatment, and benefits and harm were similar between the two modalities. Patient tolerance and symptom response should guide the choice of one over the other.
APAP or CPAP are recommended over BiPAP for initial treatment of OSA in adults. BiPAP might provide an expiratory pressure that is too low to prevent obstructive breathing. However, BiPAP therapy for OSA might be appropriate in certain patients, such as those who have not responded to treatment with APAP and CPAP or those who require very high pressures (> 20 cm H2O).
Learn more about sleep-disordered breathing and CPAP.
According to current guidelines from the AADSM, patients should be seen by their dentist for a follow-up evaluation within 30 days after appliance insertion. During the first year, patients should be re-evaluated every 6 months, and at least once annually after that to assess treatment efficacy and adherence.
At these visits, the treating dentist should use the same standardized tools and questionnaires employed during the initial evaluation to monitor symptoms and treatment response. Adjustment of the oral appliance depends on several factors, including the patient's mandibular range of motion, OSA severity, comfort, and observed changes in symptoms. A collaborative protocol between the treating dentist and the patient's medical provider should be in place to support objective and coordinated assessment.
Learn more about oral appliance therapy for OSA.
The implantable hypoglossal nerve stimulator received US Food and Drug Administration (FDA) approval in 2014 for the treatment of moderate to severe OSA in patients who have not responded to or cannot tolerate PAP therapy. As hypoglossal nerve stimulation has been shown to be most efficacious in those with a BMI < 32, an adult with moderate OSA and a BMI of 28 probably would be a good candidate for this treatment approach.
Hypoglossal nerve stimulation has not been approved in patients aged < 18 years, so a boy aged 15 years would not be a candidate. Also, the stimulator is contraindicated in patients with central sleep apnea. The safety of hypoglossal nerve stimulation has not been established in pregnant patients and should not be undertaken.
Learn more about upper airway evaluation in snoring and OSA.
An external tongue muscle stimulator device was cleared by the FDA in 2020. Intended for use 20 min/d for 6 weeks and then twice per week subsequently, the device requires far less patient time commitment than some other OSA therapy devices.
The tongue muscle stimulator is designed to be used while awake for 20-minute increments. It is indicated for snoring and mild OSA and is not indicated to treat OSA with an apnea-hypopnea index (AHI) > 15. The device is approved only for adults aged ≥ 18 years.
Learn more about macroglossia.
EPAP devices are noninvasive, valve-based devices for the treatment of mild to moderate OSA. They function by creating resistance during expiration, generating back pressure that helps keep the upper airway open during sleep. Unlike CPAP therapy, which provides constant pressure during both inhalation and exhalation, EPAP devices are passive and provide pressure only during expiration.
These devices do not require batteries or power sources. They resemble nasal pillows, like those used with many CPAP machines. Unlike oral appliances, EPAP devices do not require custom fitting. Monthly calibration is also not needed.
Learn more about pathologic conditions associated with OSA.
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