advancementsThe treatments for obstructive sleep apnea (OSA) have undergone major advancements through past decade.

Nasal continuous positive airway pressure, initially described in 1981, remains the cornerstone of therapy even today.

Advances in mask interfaces, the use of humidification, the downloading of usage information, the development of pressure delivery modifications, and reductions in the size and noise of the machines have improved the devices over the past decade.

Nevertheless, the basic premise of positive pressure delivery to splint the airway remains the primary driver of efficacy. 

Surgery for OSA, other than tracheostomy, has also been used for about the same period (uvulopalato pharyngoplasty was also initially described in 1981), but its efficacy has probably improved only marginally.

The advances in surgical techniques have come through improved patient selection, minimally invasive techniques, and the performance of outcome studies. Surgery clearly remains a second-line or third-line therapy for moderate to severe obstructive sleep apnea (OSA).

Dental appliances were also introduced over two decades ago and clearly have become more main stream in our treatment approach to OSA. Dental appliances are now considered a reasonable first-line therapy for mild OSA and perhaps even for some patients with moderate obstructive sleep apnea (OSA).

Custom-made appliances are clearly superior to those that cannot be adjusted, and in the hands of an experienced dentist or similarly trained expert, they are moderately successful for most patients.

Among the newer therapies, transnasal insufflation and nasal expiratory resistance clearly have promise, again for patients with mild to moderate obstructive sleep apnea (OSA).

Further study may determine who will benefit from such modalities. No medications have been shown to have clinically significant efficacy, and drug treatment remains adjunctive.

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Filed under: CPAP MaskCPAP TherapyDental AppliancesObstructive Sleep ApneaOral AppliancesSleepSleep ApneaSleep Apnea DevicesSleep Apnea MaskSleep Apnea Treatment

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