The 2 keys to treating sleep apnea

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The American College of Physicians has issued a new clinical guideline for treating patients with obstructive sleep apnea.

Your patients with obstructive sleep apnea (OSA) can best be treated by encouraging them to lose weight if they are overweight or obese, and through the use of continuous positive airway pressure (CPAP) treatment, according to new recommendations from the American College of Physicians (ACP).

The recommendations were published in the form of a Clinical Guideline in the October 1 issue of Annals of Internal Medicine. They are based on a systematic evidence review of published literature from 1966 through October 2012 comparing the effectiveness of various forms of treatment for OSA.

About 20 million American adults are thought to experience some form of sleep disorder, primarily OSA, and the numbers are increasing along with the percentage of the population that is either overweight or obese.

The review found that obesity is a risk factor for OSA, and that intensive weight-loss interventions help to improve scores on the Apnea-Hypopnea Index (AHI) and improves OSA symptoms, as well as bringing other health benefits.

The literature review also showed that CPAP improves scores on the Epworth Sleepiness Scale as well as the arousal index (the frequency of arousals per hour of sleep) and the AHI, and increases oxygen saturation levels. CPAP was not shown to improve quality of life, however.


As an alternative to CPAP, the guideline recommends the use of mandibular advancement devices for patients who prefer them or who experience adverse effects sometimes associated with CPAP or who find adherence difficult.

The evidence review was sponsored by the Agency for Healthcare Research and Quality.




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