Practice parameters for the medical therapy of obstructive sleep apnea.
Therapies for obstructive sleep apnea other than positive airway pressure, oral appliances, and surgical modifications of the upper airway are reviewed in this practice parameter. Several of these therapies such as weight loss and positional therapy hold some promise. Others, such as serotonergic agents, may gain credibility in the future but lack well-designed clinical trials. No practice parameters could be developed for a number of possible therapeutic modalities that had little or no evidence-based data on which to form a conclusion. The role of an organized, targeted weight-loss program either as a single therapy or as a supplement to PAP needs to be clarified. Although bariatric surgery is increasingly performed for refractory medically complicated obesity, its long-term effectiveness in treatment of obstructive sleep apnea in morbidly obese patients is not yet demonstrated. Positional therapy, or methods for preventing sleep in the supine position, has probably been underutilized due to lack of easily measured predictive factors and randomized controlled trials.
Morgenthaler
Timothy I
TI
Sleep Disorders Center, Pulm Crit Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. morgenthaler.timothy@mayo.edu
Kapen
Sheldon
S
Lee-Chiong
Teofilo
T
Alessi
Cathy
C
Boehlecke
Brian
B
Brown
Terry
T
Coleman
Jack
J
Friedman
Leah
L
Kapur
Vishesh
V
Owens
Judith
J
Pancer
Jeffrey
J
Swick
Todd
T
D003131:Combined Modality Therapy; D045422:Continuous Positive Airway Pressure; D019317:Evidence-Based Medicine; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D016896:Treatment Outcome; D015431:Weight Loss