The Interdisciplinary Weight Loss and Lifestyle Intervention for OSA INTERAPNEA study a parallel group open label randomized clinical trial included 89 men mean age 541 years in Spain with moderate to severe OSA and a BMI of 25 kgm2 or higher who were receiving CPAP therapy The trial was conducted from April 2019 to October 2020
Participants were randomly assigned to usual care with CPAP therapy n = 49 or an 8 week interdisciplinary weight loss and lifestyle intervention involving nutritional behavior change aerobic exercise sleep hygiene and alcohol and tobacco cessation along with CPAP therapy n = 40
The primary outcome was a change in the apnea hypopnea index from baseline to 8 weeks and 6 months after the intervention Secondary outcomes included changes in other OSA sleep related outcomes body weight and composition cardiometabolic risk and health related quality of life
Participants in the intervention group had a 51 greater decrease in the apnea hypopnea index compared with participants in the control group 212 vs 25 eventshour at 8 weeks This reduction was 57 greater among participants in the intervention group at 6 months 238 vs 08 eventshour
Forty five percent of participants in the intervention group no longer required CPAP therapy and 15 achieved complete OSA remission by 8 weeks At 6 months 618 of participants in the intervention group no longer required CPAP therapy and 294 achieved complete OSA remission
In addition the intervention group had greater improvements compared with the usual care group in body weight 71 kg vs 03 kg body composition 29 kg vs 14 kg cardiometabolic risk 65 mm Hg vs 22 mm Hg and health related quality of life 08 points vs 01 points by 8 weeks
Given the high prevalence of OSA its complex and reciprocal interaction with obesity and the fact that both conditions are readily treatable through an integrated behavioral intervention health care professionals and policymakers might consider this approach as a central strategy to address the substantial impact of OSA on the health and welfare of populations Almudena Carneiro Barrera PhD of the Sleep and Health Promotion Laboratory Mind Brain and Behavior Research Centre at the University of Granada in Spain and colleagues wrote in JAMA Network Open
Therapy for Obstructive Sleep Apnea
Positive Airway Pressure PAP The majority of OSA sufferers symptoms are often relieved through the use of a PAP machine PAP machines are devices that use masks that fit over the wearers nose nose and mouth or full face and deliver a gentle force of air that pushes past the blockage to allow for easier breathing at night There are 3 kinds of PAP machines for differing needs but the CPAP therapy is the most common
Continuous Positive Airway Pressure CPAP A CPAP device includes a breathing mask that sleep apnea sufferers wear when sleeping Just enough consistent air pressure is delivered via the mask to the patients airways to keep the tissue that otherwise would collapse and cause breathing pauses and snoring from closing during sleep CPAP devices are effective in treating sleep apnea but do not cure the disorder If you discontinue using your CPAP device your sleep apnea may return
Automatic Positive Airway Pressure APAP Automatic or autotitrating positive airway pressure adjusts to the air levels sleep apnea patient needs throughout the night An APAP can detect if the patients apnea is spiking and increase the air pressure then decrease the flow if the sufferer is at a peaceful non snoring state APAP therapy is useful for people who cant get comfortable with a CPAPs air pressure or for people with seasonal allergies whose breathing might be affected at different times during the night
Bilevel positive airway pressure BPAP Bilevel positive airway pressure is similar to CPAP except that BPAP adjusts the level of air being delivered depending on whether the patient is inhaling or exhaling During inhalation an electronic sensor tells the BPAP to send more air through the mask to clear the apnea causing obstruction When the user exhales the air pressure is reduced This decrease is helpful for sleep apnea sufferers who have a rough time breathing out against the constant pressure of a CPAP machine
Adaptive servo ventilation ASV The Adaptive servo ventilation device monitors breathing and adjusts air flow appropriately through the mask to match how the patient would be normally breathing if awake This adjustment can be made quickly as soon ASV detects that the patient is not breathing correctly as is the case with central sleep apnea when the brain doesnt signal the body to take a breath When the patient exhales or after the patient resumes a normal breathing pattern ASV adjusts the pressure again
Oral Appliances
Mandibular advancement devices Often used for snorers mandibular advancement devices MADs also can be helpful in curbing sleep apnea MADs look like sports mouthguards and push the lower jaw down slightly just enough to pull the tongue forward and help open the air passage
Tongue retaining mouthpieces Also common as a snoring treatment tongue retaining mouthpieces are worn in the mouth and change the position of the tongue during sleep The flow of air through the users mouth becomes less obstructed and may help lessen obstructive sleep apnea
Surgery for obstructive sleep apnea
Some patients find wearing a PAP machines mask or using an oral appliance too inconvenient Most often its because they have difficulty wearing a mask on their face a device in their mouth or find the pressure of air blown into their nose throughout the night uncomfortable
For the non compliant surgical alternatives for obstructive sleep apnea may be a practical alternative
However as OSA can be caused by different obstructions the type of surgery will be specific to each individual Some of the most common forms of OSA related surgeries are
Uvulopalatopharyngoplasty UPPP A procedure in which soft tissues in the back of the throat are removed The tissues removed are from the uvula the little soft flap of tissue that dangles in the back of the throat and parts of the soft palate If tonsils and adenoids are still intact they are often removed as well
Adenotonsillectomy Surgical removal of enlarged adenoids and tonsils is usually the first line of treatment in children with obstructive sleep apnea
Nasal Surgery For OSA sufferers whose symptoms are often caused by a deviated septum the straightening of the nasal passages or removal of the deviated cartilage can help free up the blockage causing snoring and OSA
Maxillomandibular Advancement MMA In this surgery the upper and lower parts of the jawbone are moved forward It creates an enlarged space behind the tongue and soft palate making obstructions less likely
Tracheostomy In the most severe and potentially life threatening cases of
obstructive sleep apnea it may be recommended that the patient undergo a tracheostomy In this surgical procedure a permanent opening is made in the throat to the windpipe where a breathing tube is inserted The breathing tube has a valve that is closed during the day for regular breathing and speaking and opened at night When opened during sleep air enters the lungs through the tube rather than through the upper airways allowing airflow to bypass the obstruction by entering beneath it
What Can Happen If My OSA is Left Untreated
Its important that you address your OSA symptoms early to avoid any further health complications that can arise from untreated obstructive sleep apnea These complications can range from severe and potentially fatal to mild or moderate daily nuisances
Cardiovascular problems Untreated obstructive sleep apnea can cause a strain on your heart as sudden drops in blood oxygen levels that occur during OSA increases your blood pressure High blood pressure hypertension increases the likelihood of a number of heart diseases and complications
Abnormal heart rhythms arrhythmia
Greater risk of coronary artery disease
Greater risk of heart attack or heart failure
Greater risk of having a stroke
Daytime fatigueUntreated OSA keeps your body and mind from getting a full nights sleep as you continuously wake because of breathing obstructions disturbing your sleep This leaves sufferers feeling tired and groggy throughout the day People with untreated OSA have a higher likelihood of work related accidents and driving related accidents resulting from lack of restful sleep at night
Complications with medications and surgery Medications such as sedatives narcotic analgesics and general anesthesia all aid in relaxing your upper airways that can further complicate your OSA
Other Problems associated with untreated OSA
Memory problems
Morning migraines due to reduced blood oxygen in the brain at night
Mood swings
Depression
If you have any questions or concerns regarding obstructive sleep apnea or any other sleep related questions feel free to contact The Alaska Sleep Clinic for further information and be on your way to getting the nightly rest you need
