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Semin Respir Crit Care Med 2014; 35(05): 613-620
DOI: 10.1055/s-0034-1390047
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Noncontinuous Positive Airway Pressure Therapies for Obstructive Sleep Apnea

Shirley F. Jones
1   Division of Pulmonary, Critical Care, and Sleep Medicine, Scott and White Healthcare, Texas A&M Health Science Center, Temple, Texas
,
Veronica Brito
1   Division of Pulmonary, Critical Care, and Sleep Medicine, Scott and White Healthcare, Texas A&M Health Science Center, Temple, Texas
› Author Affiliations
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Publication History

Publication Date:
29 October 2014 (online)

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Abstract

While continuous positive airway pressure is the first-line treatment for obstructive sleep apnea, many patients find this form of therapy undesirable leading to treatment nonadherence. Both mandibular advancement devices and surgical therapy offer alternative solutions for such patients. This article serves to compare the types of surgical interventions and mandibular advancement devices available, their mechanisms of action, and expected side effects. Emphasis is made on the limitations and challenges in the interpretation of the available literature due to the varying definitions of curative success. The effects of mandibular advancement devices and surgical therapy on the apnea–hypopnea index and oxygen saturation are reviewed. Patient-centered outcomes of sleepiness, quality of life, treatment preference, adherence, and their effects on disease-related outcomes of hypertension are summarized. When available, comparative effectiveness trials between these therapies versus continuous positive airway pressure are emphasized. Patient selection criteria, practice parameters, and treatment limitations are discussed.

Keywords

obstructive sleep apnea - oral appliances - mandibular advancement device - surgery - uvulopalatopharyngoplasty - tongue - tonsils - nasal surgery
 

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