Skip to main content
Top
Published in: Neurotherapeutics 4/2012

01-10-2012

New and Unconventional Treatments for Obstructive Sleep Apnea

Authors: Jose Angelo A. De Dios, Steven D. Brass

Published in: Neurotherapeutics | Issue 4/2012

Login to get access

Summary

Although continuous positive airway pressure, oral appliances and surgical modifications of the airway are considered as part of the routine management of patients with obstructive sleep apnea, many new and unconventional therapies exist. Many of the trials using these new alternatives have been limited by insufficient data, poor trial design, small sample size, unclear inclusion criteria, lack of randomization, and lack of blinding, and on occasion are biased by retrospective design. Bariatric surgery, positional therapy, auto-titrating positive airway pressure, serotonin agents, wake promoting agents, genioglossus stimulation surgery, supplemental oxygen, nasal dilators, nasal expiratory resistor devices and oropharyngeal exercises will be reviewed. As obstructive sleep apnea impacts the individual and society at large, further research is needed to explore new therapeutic treatment options for obstructive sleep apnea. Therapeutic trials for obstructive sleep apnea must be of rigorous design to prove clinical effectiveness while taking into account both patient satisfaction and cost effectiveness.
Appendix
Available only for authorised users
Literature
4.
go back to reference Martínez-García MA, Gómez-Aldaraví R, Soler-Cataluña J-J, Martínez TG, Bernácer-Alpera B, Román-Sánchez P. Positive effect of CPAP treatment on the control of difficult-to-treat hypertension. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology [Internet]. 2007 May 1 [cited 2012 Aug 13];29(5):951–7. Available from: http://erj.ersjournals.com/cgi/content/abstract/29/5/951 Martínez-García MA, Gómez-Aldaraví R, Soler-Cataluña J-J, Martínez TG, Bernácer-Alpera B, Román-Sánchez P. Positive effect of CPAP treatment on the control of difficult-to-treat hypertension. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology [Internet]. 2007 May 1 [cited 2012 Aug 13];29(5):951–7. Available from: http://​erj.​ersjournals.​com/​cgi/​content/​abstract/​29/​5/​951
7.
go back to reference Martínez-García MA, Soler-Cataluña JJ, Ejarque-Martínez L, Soriano Y, Román-Sánchez P, Illa FB, et al. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. American journal of respiratory and critical care medicine [Internet]. 2009 Jul 1 [cited 2012 Aug 13];180(1):36–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19406983 Martínez-García MA, Soler-Cataluña JJ, Ejarque-Martínez L, Soriano Y, Román-Sánchez P, Illa FB, et al. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. American journal of respiratory and critical care medicine [Internet]. 2009 Jul 1 [cited 2012 Aug 13];180(1):36–41. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​19406983
8.
go back to reference McDaid C, Griffin S, Weatherly H, Durée K, van der Burgt M, van Hout S, et al. Continuous positive airway pressure devices for the treatment of obstructive sleep apnoea-hypopnoea syndrome: a systematic review and economic analysis. Health technology assessment (Winchester, England) [Internet]. 2009 Jan [cited 2012 Aug 13];13(4):iii–iv, xi–xiv, 1–119, 143–274. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19103134 McDaid C, Griffin S, Weatherly H, Durée K, van der Burgt M, van Hout S, et al. Continuous positive airway pressure devices for the treatment of obstructive sleep apnoea-hypopnoea syndrome: a systematic review and economic analysis. Health technology assessment (Winchester, England) [Internet]. 2009 Jan [cited 2012 Aug 13];13(4):iii–iv, xi–xiv, 1–119, 143–274. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​19103134
9.
go back to reference Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. The American review of respiratory disease [Internet]. 1993 Apr [cited 2012 Jun 5];147(4):887–95. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8466125 Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. The American review of respiratory disease [Internet]. 1993 Apr [cited 2012 Jun 5];147(4):887–95. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​8466125
13.
go back to reference Bravata DM, Ferguson J, Miech EJ, Agarwal R, McClain V, Austin C, et al. Diagnosis and Treatment of Sleep Apnea in patients’ homes: the rationale and methods of the “GoToSleep” randomized-controlled trial. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine [Internet]. 2012 Mar 15 [cited 2012 May 31];8(1):27–35. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22334806 Bravata DM, Ferguson J, Miech EJ, Agarwal R, McClain V, Austin C, et al. Diagnosis and Treatment of Sleep Apnea in patients’ homes: the rationale and methods of the “GoToSleep” randomized-controlled trial. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine [Internet]. 2012 Mar 15 [cited 2012 May 31];8(1):27–35. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​22334806
14.
go back to reference Brown TM, Coleman J, Friedman L, Kapen S, Kapur VK, Kramer M. Practice Parameters for the Use of Continuous and Bilevel Positive Airway Pressure Devices to Treat Adult Patients With Sleep-Related Breathing Disorders. 1915; Brown TM, Coleman J, Friedman L, Kapen S, Kapur VK, Kramer M. Practice Parameters for the Use of Continuous and Bilevel Positive Airway Pressure Devices to Treat Adult Patients With Sleep-Related Breathing Disorders. 1915;
21.
go back to reference Phillips BA, Schmitt FA, Berry DT, Lamb DG, Amin M, Cook YR. Treatment of obstructive sleep apnea. A preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA. Chest [Internet]. 1990 Aug [cited 2012 Jun 6];98(2):325–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2198135 Phillips BA, Schmitt FA, Berry DT, Lamb DG, Amin M, Cook YR. Treatment of obstructive sleep apnea. A preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA. Chest [Internet]. 1990 Aug [cited 2012 Jun 6];98(2):325–30. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​2198135
30.
go back to reference Permut I, Chatila W, Crocetti J, Gaughan JP, Krachman SL. Comparison of Positional Therapy to CPAP in Patients with. :1–6. Permut I, Chatila W, Crocetti J, Gaughan JP, Krachman SL. Comparison of Positional Therapy to CPAP in Patients with. :1–6.
33.
go back to reference Bignold JJ, Bios BS, Deans-costi G, Goldsworthy MR, Robertson CA. Poor Long-Term Patient Compliance with the Tennis Ball Technique for Treating. 2008;4–6. Bignold JJ, Bios BS, Deans-costi G, Goldsworthy MR, Robertson CA. Poor Long-Term Patient Compliance with the Tennis Ball Technique for Treating. 2008;4–6.
35.
go back to reference Randerath WJ, Verbraecken J, Andreas S, Bettega G, Boudewyns a, Hamans E, et al. Non-CPAP therapies in obstructive sleep apnoea. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology [Internet]. 2011 May [cited 2012 May 31];37(5):1000–28. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21406515 Randerath WJ, Verbraecken J, Andreas S, Bettega G, Boudewyns a, Hamans E, et al. Non-CPAP therapies in obstructive sleep apnoea. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology [Internet]. 2011 May [cited 2012 May 31];37(5):1000–28. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​21406515
36.
go back to reference Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA : the journal of the American Medical Association [Internet]. 2004 Oct 13 [cited 2012 Mar 10];292(14):1724–37. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15479938 Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA : the journal of the American Medical Association [Internet]. 2004 Oct 13 [cited 2012 Mar 10];292(14):1724–37. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​15479938
39.
go back to reference Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. American journal of respiratory and critical care medicine [Internet]. 2009 May 15 [cited 2012 Mar 22];179(10):962–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19234106 Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. American journal of respiratory and critical care medicine [Internet]. 2009 May 15 [cited 2012 Mar 22];179(10):962–6. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​19234106
41.
go back to reference Schonhofer B. Effect of Nasal-Valve Dilation on Obstructive Sleep Apnea. Chest [Internet]. 2000 Sep 1 [cited 2012 May 31];118(3):587–90. Available from: http://www.chestjournal.org/cgi/doi/10.1378/chest.118.3.587 Schonhofer B. Effect of Nasal-Valve Dilation on Obstructive Sleep Apnea. Chest [Internet]. 2000 Sep 1 [cited 2012 May 31];118(3):587–90. Available from: http://​www.​chestjournal.​org/​cgi/​doi/​10.​1378/​chest.​118.​3.​587
44.
go back to reference Kezirian EJ, Boudewyns A, Eisele DW, Schwartz AR, Smith PL, Van de Heyning PH, et al. Electrical stimulation of the hypoglossal nerve in the treatment of obstructive sleep apnea. Sleep medicine reviews [Internet]. 2010 Oct [cited 2012 Mar 22];14(5):299–305. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20116305 Kezirian EJ, Boudewyns A, Eisele DW, Schwartz AR, Smith PL, Van de Heyning PH, et al. Electrical stimulation of the hypoglossal nerve in the treatment of obstructive sleep apnea. Sleep medicine reviews [Internet]. 2010 Oct [cited 2012 Mar 22];14(5):299–305. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​20116305
45.
go back to reference Dotan Y, Golibroda T, Oliven R, Netzer a, Gaitini L, Toubi a, et al. Parameters affecting pharyngeal response to genioglossus stimulation in sleep apnoea. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology [Internet]. 2011 Aug [cited 2012 May 31];38(2):338–47. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21177842 Dotan Y, Golibroda T, Oliven R, Netzer a, Gaitini L, Toubi a, et al. Parameters affecting pharyngeal response to genioglossus stimulation in sleep apnoea. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology [Internet]. 2011 Aug [cited 2012 May 31];38(2):338–47. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​21177842
Metadata
Title
New and Unconventional Treatments for Obstructive Sleep Apnea
Authors
Jose Angelo A. De Dios
Steven D. Brass
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
Neurotherapeutics / Issue 4/2012
Print ISSN: 1933-7213
Electronic ISSN: 1878-7479
DOI
https://doi.org/10.1007/s13311-012-0146-5

Other articles of this Issue 4/2012

Neurotherapeutics 4/2012 Go to the issue