Treatment of OSA

• Current NHS treatments for OSAHS
• NICE Guidelines – OSA Alliance webinar

There are an increasing number of treatment options for OSAHS with more being evaluated in clinical trials. This enables us to recommend more personalised OSAHS care – based on patient choice, patient symptoms and severity of OSAHS on sleep study. The OSA Alliance facilitates sharing of good practice, efficient pathways and a united voice to work towards adequate and equitable resources across the UK.

Current NHS Treatments for OSAHS

Current NHS treatments for OSAHS include:

Lifestyle changes
Support and information on losing weight, stopping smoking, reducing alcohol intake, excluding dairy drinks before sleep, and improving sleep hygiene

Continuous positive airway pressure (CPAP) applied to upper airway via a mask, tubing, and machine to splint it open and prevent its closure

Mandibular Advancement Splint (MAS)
The principal mode of action is anatomical action to increase the air space in the pharynx by placing the soft tissues of the pharynx under stretch with jaw protrusion

Postural changes: pillows/cushions to avoid rolling onto back during sleep.

Treatment Priority

The priority of OSAHS treatment for moderate and severe OSAHS is usually:  CPAP – MAD – Lifestyle changes.  In mild OSAHS and snoring the order is usually: MAD – Lifestyle change – CPAP and finally surgery then hypoglossal nerve stimulation.

Surgery – while undertaken infrequently, a tonsillectomy may be performed if large obstructive tonsils, mandibular osteotomy, targeted ENT surgery such as nasal, tonsillar/palatal, tongue base and/or epiglottis surgery, usually only if severe OSAHS and people have been unable to tolerate CPAP and a customised mandibular advancement splint despite medically supervised attempts.  

Hypoglossal nerve stimulation – in some centres only. Aims to treat OSAHS by preventing the tongue prolapsing backwards and causing upper airway obstruction during sleep, by delivering an electrical current to the hypoglossal nerve. This contracts the genioglossus muscle, the major muscle responsible for tongue protrusion, and all other intrinsic muscles of the tongue.

Using general anaesthesia, a neurostimulator is implanted in an infraclavicular subcutaneous pocket and a stimulating lead is placed on the main trunk of the hypoglossal nerve. The neurostimulator delivers electrical pulses to the hypoglossal nerve. With some devices, stimulation can be synchronised with respiration using sensing leads that measure changes in breathing. The stimulator is programmed and controlled wirelessly to adapt to specific patient needs.  This is expensive and should be considered after all options above have been exhausted.

Treatment of Rhinitis
Nasal douche and nasal sprays – to reduce nasal congestion and mucus production.

New Treatments
There are newer treatments and techniques being introduced in some areas of clinical practice which are awaiting full evaluation, for example neuromuscular electrical therapy of tongue muscles

Nice Guidelines

NICE Guidelines on OSAHS OHS and OSAHS-COPD Overlap Syndrome – Workshop session 2 Treating OSA.