title: Non-CPAP therapies in obstructive sleep apnoea.
abstract: In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS. This report summarises the efficacy of alternative treatment options in OSAS. An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine. Evidence supports the use of mandibular advancement devices in mild to moderate OSAS. Maxillomandibular osteotomy seems to be as efficient as continuous positive airway pressure (CPAP) in patients who refuse conservative treatment. Distraction osteogenesis is usefully applied in congenital micrognathia or midface hypoplasia. There is a trend towards improvment after weight reduction. Positional therapy is clearly inferior to CPAP and long-term compliance is poor. Drugs, nasal dilators and apnoea triggered muscle stimulation cannot be recommended as effective treatments of OSAS at the moment. Nasal surgery, radiofrequency tonsil reduction, tongue base surgery, uvulopalatal flap, laser midline glossectomy, tongue suspension and genioglossus advancement cannot be recommended as single interventions. Uvulopalatopharyngoplasty, pillar implants and hyoid suspension should only be considered in selected patients and potential benefits should be weighed against the risk of long-term side-effects. Multilevel surgery is only a salvage procedure for OSA patients.
authors.affiliation: Institute for Pneumology at the University Witten/Herdecke,Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany. randerath@klinik-bethanien.de
authors.forename: W J
authors.initials: WJ
authors.lastname: Randerath
authors.forename: J
authors.initials: J
authors.lastname: Verbraecken
authors.forename: S
authors.initials: S
authors.lastname: Andreas
authors.forename: G
authors.initials: G
authors.lastname: Bettega
authors.forename: A
authors.initials: A
authors.lastname: Boudewyns
authors.forename: E
authors.initials: E
authors.lastname: Hamans
authors.forename: F
authors.initials: F
authors.lastname: Jalbert
authors.forename: J R
authors.initials: JR
authors.lastname: Paoli
authors.forename: B
authors.initials: B
authors.lastname: Sanner
authors.forename: I
authors.initials: I
authors.lastname: Smith
authors.forename: B A
authors.initials: BA
authors.lastname: Stuck
authors.forename: L
authors.initials: L
authors.lastname: Lacassagne
authors.forename: M
authors.initials: M
authors.lastname: Marklund
authors.forename: J T
authors.initials: JT
authors.lastname: Maurer
authors.forename: J L
authors.initials: JL
authors.lastname: Pepin
authors.forename: A
authors.initials: A
authors.lastname: Valipour
authors.forename: T
authors.initials: T
authors.lastname: Verse
authors.forename: I
authors.initials: I
authors.lastname: Fietze
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D006928:Hyoid Bone / Q000601:surgery; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D009666:Nose / Q000601:surgery; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods; D010159:Palate / Q000601:surgery; D010614:Pharynx / Q000601:surgery; D016879:Salvage Therapy; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014059:Tongue / Q000601:surgery; D055815:Young Adult