A continuous positive airway pressure machine and wearing a mouthpiece have been found to be the most successful treatments for obstructive sleep apnea in helping nighttime breathing, according to a report issued by AHRQ (Agency for Healthcare Research and Quality). The authors said the CPAP (continuous positive airway pressure) machine was backed by the most compelling evidence. The mouthpiece is called MAD (mandibular advancement device)
The comparative effectiveness review was done by researchers at the Tufts Medical center Evidence-based Practice Center for AHRQ’s Effective Health Care Program.
The authors of the report stress that all treatments have potential side effects.
The authors explained that approximately 12 million Americans are thought to suffer from sleep apnea. Most likely, there are several more millions who are currently undiagnosed.
Although weight loss and surgery were found to help with sleep apnea symptoms, they do not appear to be as effective as CPAP and MAD, according to available evidence.
AHRQ Director Carolyn M. Clancy, M.D., said:
“Obstructive sleep apnea is a frustrating and debilitating condition for so many Americans, and millions of people don’t even know they have it. The resultant poor sleep and daytime sleepiness can lead to work-related or driving accidents. These guides and this new report will help patients and their doctors understand what treatment options might be best for them.”
The companion guides give a synopsis of the findings of the report for doctors and patients.
The consumer guide gives a definition of sleep apnea for patients and their families – it also offers possible treatment options, a list of questions to ask the doctors, plus some basic information on costs.
The clinician guide covers all the above topics, plus “confidence ratings” on current scientific evidence, as well as a “clinical bottom line” so that doctors have some useful tools when discussing treatment options with patients.
Patients with obstructive sleep apnea stop breathing during sleep because of the repeated collapse and blockage of the upper airway while they are asleep. It is a long-term (chronic) disorder. All of us have very brief moments when we stop breathing during sleep. For those with obstructive sleep apnea, this happens more often and for longer periods. They will commonly start breathing again with a choking sound or snort, and stop breathing for or five times an hour, or more – in some cases, every two to three minutes.
The CPAP is commonly prescribed by doctors for obstructive sleep apnea treatment. The mask pushes a continuous stream of air through the patient’s nose to keep the airway and throat open. There are several types of CPAP machines and masks – some fit snugly over the nose, while others cover the mouth and nose.
The CPAP machine, however, does have some undesirable side effects. The patient may end up with a dry nose, have nosebleeds and experience chest discomfort. Some patients say they feel trapped. In some cases, patients abandon treatment because the side effects are too unpleasant. According to the report, the CPAP machine is only successful if the patient uses it every night.
The MAD is a mouthpiece that keeps the jaw forward, thus keeping the airway open – it is made of plastic. It is a good alternative for those who cannot tolerate the CPAP machine. Although effective, the MAD can occasionally loosen or damage teeth.
Although surgery is sometimes used to treat patients with obstructive sleep apnea, the authors said they did not find enough compelling evidence to determine whether or not it is better than non-surgical therapies.
Weight loss programs, medications and other treatments were also examined by the authors, but they wrote that overall the evidence was not enough to draw any conclusions regarding them.
Although there are probably millions of Americans with obstructive sleep apnea who do not know they have it, the report did not identify the best way to diagnose the condition.
Written by Christian Nordqvist