Table 7.
Primary nonsurgical interventions for obstructive sleep apnea syndrome (OSAS)
| Treatment | Description | Indications and advantages | Downsides to treatment |
|---|---|---|---|
| Behavioral intervention | |||
| Psychoeducation | Targeted mental health counseling should be carried out, communication with patients should be strengthened, and knowledge of the disease should be introduced to patients in plain language. Patients should be advised to stop drinking, smoking, and taking sedatives | It can help OSAS patients achieve a good psychological state in order to maintain a positive attitude toward the disease, which also contributes to improving patient compliance for subsequent treatment measures | |
| Weight loss709–711 | Diet control, exercise therapy, and drug treatment | It is recommended for all overweight and obese patients diagnosed with OSAS; weight loss is beneficial for health and can improve cardiovascular and metabolic diseases and improve quality of life | It takes a long time; may not be effective for some patients; weight loss is hard to stick to |
| Exercise589,712 | Choose suitable aerobic exercise, such as jogging, walking, swimming, and ball games | Contributes to weight control; it improves apnea independently of other mechanisms; reduces the risk of chronic diseases | May be difficult for patients with excessive body weight, muscle and joint damage, and severe cardiopulmonary dysfunction |
| Positional treatment607 | Avoid sleeping in the supine position; tennis ball technique; chest position therapy device; neck position therapy device | Alternative treatments for patients with OSAS who are intolerant of PAP therapy; self-positioning has no cost; it is not expensive to wear | It is only applicable to patients with positional OSAS; shoulder problems or other physical disabilities can affect sleep in the side-lying position; adherence to treatment remains an issue |
| Pharmacologic Therapy46 | Medical therapy focuses on improving upper airway muscle tone, ventilatory drive, or the arousal threshold | Complementary therapeutic approaches; to improve the treatment compliance of patients; availability of pharmacologic therapy opens up new directions for the pathophysiological phenotype of OSAS | There are currently no marker pharmacologic treatments available in OSAS; much effort has been made to pharmacologically improve airway patency, but a large number of studies have not been of very high quality; relevant experimental models of OSAS are lacking |
| Noninvasive medical treatment | |||
| Positive airway pressure (PAP)614,713 | PAP treatment delivers pressure to the upper airway by circulating compressed room air via a mask worn over the nose or the nose and mouth. There are three modes of PAP delivery: CPAP, BPAP, and APAP | First-line treatment of OSAS; it can effectively eliminate nocturnal snoring and other respiratory events, correct nocturnal hypoxemia, and improve sleepiness and blood pressure | Approximately one-third of patients have poor tolerability; may cause nasal injury, leading to local compression necrosis; not easily fixed |
| Mandibular advancement device (oral appliances)626,714 | These devices are manufactured to accommodate the upper and lower teeth, are worn in the mouth, and during sleep, the lower jaw is kept in the anterior position | Patients with mild to moderate OSAS; PAP intolerant patients, PAP nonresponder patients, PAP treatment failure patients | There is a high cost and time required to build the equipment; temporomandibular joint discomfort, tooth pain, dryness of the mouth, or excessive saliva production |