Treating OSA: Current and emerging therapies beyond CPAP

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art_LORENZI-FILHO_Treating_OSA_Current_and_emerging_therapies_beyond_CPAP_2017.PDF (1.69 MB)
Citações na Scopus
65
Tipo de produção
article
Data de publicação
2017
Editora
WILEY
DOI
Indexadores
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Autores
ALMEIDA, Fernanda R.
STROLLO, Patrick J.
Autor de Grupo de pesquisa
Editores
Coordenadores
Organizadores
Citação
RESPIROLOGY, v.22, n.8, p.1500-1507, 2017
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Continuous positive airway pressure (CPAP) is the standard treatment for moderate-to-severe obstructive sleep apnoea (OSA). However, adherence to CPAP is limited and non-CPAP therapies are frequently explored. Oral appliance (OA) therapy is currently widely used for the treatment of snoring, mild, moderate and severe OSA. The most commonly used and studied OA consists of a maxillary and mandibular splint which hold the lower jaw forward during sleep. The efficacy of OA is inferior to CPAP; however, the effectiveness as measured by sleepiness, quality of life, endothelial function and blood pressure is similar likely due to higher acceptance and subjective adherence. Upper airway stimulation augments neural drive by unilaterally stimulating the hypoglossal nerve. The Stimulation Therapy for Apnea Reduction (STAR) study enrolled 126 patients and demonstrated a 68% reduction in OSA severity. A high upfront cost and variable response are the main limitations. Oropharyngeal exercises consist of a set of isometric and isotonic exercises involving the tongue, soft palate and lateral pharyngeal wall. The collective reported trials (n = 120) showed that oropharyngeal exercises can ameliorate OSA and snoring (similar to 30-40%). Nasal EPAP devices consist of disposable one-way resister valve. A systematic review (n = 345) showed that nasal EPAP reduced OSA severity by 53%. The Winx device consists of a mouthpiece placed inside the oral cavity that is connected by tubing to a console that generates negative pressure. Winx may provide successful therapy for similar to 30-40% of OSA patients. In conclusion, several non-CPAP therapies to treat OSA are currently available.
Palavras-chave
continuous positive airway pressure, hypoglossal nerve stimulation, oral appliance, sleep apnea treatment
URI
https://observatorio.fm.usp.br/handle/OPI/24475
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Coleções
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/09