People diagnosed with obstructive sleep apnea (OSA) should not consider surgery, according to new recommendations from the American College of Physicians (ACP). Instead, ACP recommends that patients lose weight and use continuous positive airway pressure (CPAP) as initial therapy.

More than 18 million American adults have sleep apnea, which increases the risk of high blood pressure, heart attack, stroke, heart failure, and diabetes and increases the chance of driving or other accidents. Sleep apnea is a leading cause of excessive daytime sleepiness.

The most common type of sleep apnea is OSA, a condition in which the airway collapses or becomes blocked during sleep causing shallow breathing or breathing pauses lasting from a few seconds to minutes. The evidence shows that the incidence of OSA is rising, likely because of the increasing rates of obesity. A CPAP machine helps because it uses mild air pressure delivered through a face mask to open airways and keep them from collapsing or becoming blocked. However, for patients who do not tolerate or comply with CPAP treatment, ACP recommends a mandibular advancement device (MAD) as an alternative therapy.

The available evidence was limited on treating OSA with surgery, which is associated with serious adverse events and should not be used as initial treatment. ACP developed the guideline based on a systematic evidence review sponsored by the Agency for Healthcare Research and Quality.

Management of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians , Ann Intern Med. Published online 24 September 2013, doi:10.7326/0003-4819-159-7-201310010-00704