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. 1987 Nov;147(5):561–568.

Treatment of the Obstructive Sleep Apnea Syndrome

Robert V Wiggins, Wolfgang W Schmidt-Nowara
PMCID: PMC1025945  PMID: 3321711

Abstract

The obstructive sleep apnea syndrome is a disorder of sleep and breathing that is being recognized with increasing frequency. The pathophysiologic consequences range from mild sleepiness to life-threatening cardiovascular and respiratory decompensation. The primary forms of treatment are directed at modifying the upper airway with either an operation or continuous positive airway pressure. Aside from tracheostomy, which is virtually always successful, other forms of treatment have met with varying results. Ancillary therapy, including oxygen, weight loss and drugs, is often helpful but seldom curative. Follow-up sleep studies are necessary to evaluate the effectiveness of treatment. Selecting therapy for a patient with obstructive sleep apnea requires a comprehensive evaluation including polysomnography, special examinations of the upper airway and assessing the cardiopulmonary status. Therapy is based on the severity of disease and must be tailored to each patient.

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Selected References

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  1. Afzelius L. E., Elmqvist D., Hougaard K., Laurin S., Nilsson B., Risberg A. M. Sleep apnea syndrome--an alternative treatment to tracheostomy. Laryngoscope. 1981 Feb;91(2):285–291. doi: 10.1288/00005537-198102000-00018. [DOI] [PubMed] [Google Scholar]
  2. Anch A. M., Remmers J. E., Bunce H., 3rd Supraglottic airway resistance in normal subjects and patients with occlusive sleep apnea. J Appl Physiol Respir Environ Exerc Physiol. 1982 Nov;53(5):1158–1163. doi: 10.1152/jappl.1982.53.5.1158. [DOI] [PubMed] [Google Scholar]
  3. BICKELMANN A. G., BURWELL C. S., ROBIN E. D., WHALEY R. D. Extreme obesity associated with alveolar hypoventilation; a Pickwickian syndrome. Am J Med. 1956 Nov;21(5):811–818. doi: 10.1016/0002-9343(56)90094-8. [DOI] [PubMed] [Google Scholar]
  4. Bear S. E., Priest J. H. Sleep apnea syndrome: correction with surgical advancement of the mandible. J Oral Surg. 1980 Jul;38(7):543–549. [PubMed] [Google Scholar]
  5. Bonora M., St John W. M., Bledsoe T. A. Differential elevation by protriptyline and depression by diazepam of upper airway respiratory motor activity. Am Rev Respir Dis. 1985 Jan;131(1):41–45. doi: 10.1164/arrd.1985.131.1.41. [DOI] [PubMed] [Google Scholar]
  6. Borowiecki B. D., Sassin J. F. Surgical treatment of sleep apnea. Arch Otolaryngol. 1983 Aug;109(8):508–512. doi: 10.1001/archotol.1983.00800220014004. [DOI] [PubMed] [Google Scholar]
  7. Bradley T. D., McNicholas W. T., Rutherford R., Popkin J., Zamel N., Phillipson E. A. Clinical and physiologic heterogeneity of the central sleep apnea syndrome. Am Rev Respir Dis. 1986 Aug;134(2):217–221. doi: 10.1164/arrd.1986.134.2.217. [DOI] [PubMed] [Google Scholar]
  8. Bradley T. D., Phillipson E. A. Pathogenesis and pathophysiology of the obstructive sleep apnea syndrome. Med Clin North Am. 1985 Nov;69(6):1169–1185. doi: 10.1016/s0025-7125(16)30981-6. [DOI] [PubMed] [Google Scholar]
  9. Brown I. G., Bradley T. D., Phillipson E. A., Zamel N., Hoffstein V. Pharyngeal compliance in snoring subjects with and without obstructive sleep apnea. Am Rev Respir Dis. 1985 Aug;132(2):211–215. doi: 10.1164/arrd.1985.132.2.211. [DOI] [PubMed] [Google Scholar]
  10. Brownell L. G., West P., Sweatman P., Acres J. C., Kryger M. H. Protriptyline in obstructive sleep apnea: a double-blind trial. N Engl J Med. 1982 Oct 21;307(17):1037–1042. doi: 10.1056/NEJM198210213071701. [DOI] [PubMed] [Google Scholar]
  11. Caldarelli D. D., Cartwright R. D., Lilie J. K. Obstructive sleep apnea: variations in surgical management. Laryngoscope. 1985 Sep;95(9 Pt 1):1070–1073. [PubMed] [Google Scholar]
  12. Cartwright R. D., Lloyd S., Lilie J., Kravitz H. Sleep position training as treatment for sleep apnea syndrome: a preliminary study. Sleep. 1985;8(2):87–94. doi: 10.1093/sleep/8.2.87. [DOI] [PubMed] [Google Scholar]
  13. Cartwright R. D., Samelson C. F. The effects of a nonsurgical treatment for obstructive sleep apnea. The tongue-retaining device. JAMA. 1982 Aug 13;248(6):705–709. [PubMed] [Google Scholar]
  14. Charuzi I., Ovnat A., Peiser J., Saltz H., Weitzman S., Lavie P. The effect of surgical weight reduction on sleep quality in obesity-related sleep apnea syndrome. Surgery. 1985 May;97(5):535–538. [PubMed] [Google Scholar]
  15. Clark R. W., Schmidt H. S., Schaal S. F., Boudoulas H., Schuller D. E. Sleep apnea: treatment with protriptyline. Neurology. 1979 Sep;29(9 Pt 1):1287–1292. doi: 10.1212/wnl.29.9_part_1.1287. [DOI] [PubMed] [Google Scholar]
  16. Coccagna G., di Donato G., Verucchi P., Cirignotta F., Mantovani M., Lugaresi E. Hypersomnia with periodic apneas in acquired micrognathia. A bird-like face syndrome. Arch Neurol. 1976 Nov;33(11):769–776. doi: 10.1001/archneur.1976.00500110037007. [DOI] [PubMed] [Google Scholar]
  17. Conway W. A., Victor L. D., Magilligan D. J., Jr, Fujita S., Zorick F. J., Roth T. Adverse effects of tracheostomy for sleep apnea. JAMA. 1981 Jul 24;246(4):347–350. [PubMed] [Google Scholar]
  18. Dayal V. S., Phillipson E. A. Nasal surgery in the management of sleep apnea. Ann Otol Rhinol Laryngol. 1985 Nov-Dec;94(6 Pt 1):550–554. doi: 10.1177/000348948509400605. [DOI] [PubMed] [Google Scholar]
  19. Eliaschar I., Lavie P., Halperin E., Gordon C., Alroy G. Sleep apneic episodes as indications for adenotonsillectomy. Arch Otolaryngol. 1980 Aug;106(8):492–496. doi: 10.1001/archotol.1980.00790320044011. [DOI] [PubMed] [Google Scholar]
  20. Fee W. E., Jr, Ward P. H. Permanent tracheostomy: a new surgical technique. Ann Otol Rhinol Laryngol. 1977 Sep-Oct;86(5 Pt 1):635–638. doi: 10.1177/000348947708600517. [DOI] [PubMed] [Google Scholar]
  21. Fujita S., Conway W., Zorick F., Roth T. Surgical correction of anatomic azbnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg. 1981 Nov-Dec;89(6):923–934. doi: 10.1177/019459988108900609. [DOI] [PubMed] [Google Scholar]
  22. Gold A. R., Schwartz A. R., Bleecker E. R., Smith P. L. The effect of chronic nocturnal oxygen administration upon sleep apnea. Am Rev Respir Dis. 1986 Nov;134(5):925–929. doi: 10.1164/arrd.1986.134.5.925. [DOI] [PubMed] [Google Scholar]
  23. Guilleminault C., Riley R., Powell N. Obstructive sleep apnea and abnormal cephalometric measurements. Implications for treatment. Chest. 1984 Nov;86(5):793–794. doi: 10.1378/chest.86.5.793. [DOI] [PubMed] [Google Scholar]
  24. Guilleminault C., Simmons F. B., Motta J., Cummiskey J., Rosekind M., Schroeder J. S., Dement W. C. Obstructive sleep apnea syndrome and tracheostomy. Long-term follow-up experience. Arch Intern Med. 1981 Jul;141(8):985–988. [PubMed] [Google Scholar]
  25. Haponik E. F., Smith P. L., Bohlman M. E., Allen R. P., Goldman S. M., Bleecker E. R. Computerized tomography in obstructive sleep apnea. Correlation of airway size with physiology during sleep and wakefulness. Am Rev Respir Dis. 1983 Feb;127(2):221–226. doi: 10.1164/arrd.1983.127.2.221. [DOI] [PubMed] [Google Scholar]
  26. Harman E. M., Wynne J. W., Block A. J. The effect of weight loss on sleep-disordered breathing and oxygen desaturation in morbidly obese men. Chest. 1982 Sep;82(3):291–294. doi: 10.1378/chest.82.3.291. [DOI] [PubMed] [Google Scholar]
  27. Heimer D., Scharf S. M., Lieberman A., Lavie P. Sleep apnea syndrome treated by repair of deviated nasal septum. Chest. 1983 Aug;84(2):184–185. doi: 10.1378/chest.84.2.184. [DOI] [PubMed] [Google Scholar]
  28. Ingbar D. H., Gee J. B. Pathophysiology and treatment of sleep apnea. Annu Rev Med. 1985;36:369–395. doi: 10.1146/annurev.me.36.020185.002101. [DOI] [PubMed] [Google Scholar]
  29. Irvine B. W., Dayal V. S., Phillipson E. A. Sleep apnea due to nasal valve obstruction. J Otolaryngol. 1984 Feb;13(1):37–38. [PubMed] [Google Scholar]
  30. Issa F. G., Sullivan C. E. Reversal of central sleep apnea using nasal CPAP. Chest. 1986 Aug;90(2):165–171. doi: 10.1378/chest.90.2.165. [DOI] [PubMed] [Google Scholar]
  31. Issa F. G., Sullivan C. E. The immediate effects of nasal continuous positive airway pressure treatment on sleep pattern in patients with obstructive sleep apnea syndrome. Electroencephalogr Clin Neurophysiol. 1986 Jan;63(1):10–17. doi: 10.1016/0013-4694(86)90056-8. [DOI] [PubMed] [Google Scholar]
  32. Jamieson A., Guilleminault C., Partinen M., Quera-Salva M. A. Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep. 1986 Dec;9(4):469–477. doi: 10.1093/sleep/9.4.469. [DOI] [PubMed] [Google Scholar]
  33. Katsantonis G. P., Walsh J. K., Schweitzer P. K., Friedman W. H. Further evaluation of uvulopalatopharyngoplasty in the treatment of obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 1985 Apr;93(2):244–250. doi: 10.1177/019459988509300223. [DOI] [PubMed] [Google Scholar]
  34. Klein M., Reynolds L. G. Relief of sleep-related oropharyngeal airway obstruction by continuous insufflation of the pharynx. Lancet. 1986 Apr 26;1(8487):935–939. doi: 10.1016/s0140-6736(86)91043-3. [DOI] [PubMed] [Google Scholar]
  35. Kravath R. E., Pollak C. P., Borowiecki B. Hypoventilation during sleep in children who have lymphoid airway obstruction treated by nasopharyngeal tube and T and A. Pediatrics. 1977 Jun;59(6):865–871. [PubMed] [Google Scholar]
  36. Kuhlo W., Doll E., Franck M. C. Erfolgreiche Behandlung eines Pickwick-Syndroms durch eine Dauertrachealkanüle. Dtsch Med Wochenschr. 1969 Jun 13;94(24):1286–1290. doi: 10.1055/s-0028-1111209. [DOI] [PubMed] [Google Scholar]
  37. Kuna S. T., Remmers J. E. Neural and anatomic factors related to upper airway occlusion during sleep. Med Clin North Am. 1985 Nov;69(6):1221–1242. doi: 10.1016/s0025-7125(16)30984-1. [DOI] [PubMed] [Google Scholar]
  38. Lavie P., Zomer J., Eliaschar I., Joachim Z., Halpern E., Rubin A. H., Alroy G. Excessive daytime sleepiness and insomnia. Arch Otolaryngol. 1982 Jun;108(6):373–377. [PubMed] [Google Scholar]
  39. Lombard R. M., Jr, Zwillich C. W. Medical therapy of obstructive sleep apnea. Med Clin North Am. 1985 Nov;69(6):1317–1335. doi: 10.1016/s0025-7125(16)30989-0. [DOI] [PubMed] [Google Scholar]
  40. Martin R. J., Pennock B. E., Orr W. C., Sanders M. H., Rogers R. M. Respiratory mechanics and timing during sleep in occlusive sleep apnea. J Appl Physiol Respir Environ Exerc Physiol. 1980 Mar;48(3):432–437. doi: 10.1152/jappl.1980.48.3.432. [DOI] [PubMed] [Google Scholar]
  41. Martin R. J., Sanders M. H., Gray B. A., Pennock B. E. Acute and long-term ventilatory effects of hyperoxia in the adult sleep apnea syndrome. Am Rev Respir Dis. 1982 Feb;125(2):175–180. doi: 10.1164/arrd.1982.125.2.175. [DOI] [PubMed] [Google Scholar]
  42. Onal E., Lopata M., O'Connor T. Pathogenesis of apneas in hypersomnia-sleep apnea syndrome. Am Rev Respir Dis. 1982 Feb;125(2):167–174. doi: 10.1164/arrd.1982.125.2.167. [DOI] [PubMed] [Google Scholar]
  43. Orr W. C., Martin R. J. Obstructive sleep apnea associated with tonsillar hypertrophy in adults. Arch Intern Med. 1981 Jul;141(8):990–992. [PubMed] [Google Scholar]
  44. Patton T. J., Thawley S. E., Waters R. C., Vandermeer P. J., Ogura J. H. Expansion hyoidplasty: a potential surgical procedure designed for selected patients with obstructive sleep apnea syndrome. Experimental canine results. Laryngoscope. 1983 Nov;93(11 Pt 1):1387–1396. [PubMed] [Google Scholar]
  45. Perks W. H., Horrocks P. M., Cooper R. A., Bradbury S., Allen A., Baldock N., Prowse K., van't Hoff W. Sleep apnoea in acromegaly. Br Med J. 1980 Mar 29;280(6218):894–897. doi: 10.1136/bmj.280.6218.894. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Rajagopal K. R., Abbrecht P. H., Derderian S. S., Pickett C., Hofeldt F., Tellis C. J., Zwillich C. W. Obstructive sleep apnea in hypothyroidism. Ann Intern Med. 1984 Oct;101(4):491–494. doi: 10.7326/0003-4819-101-4-491. [DOI] [PubMed] [Google Scholar]
  47. Rajagopal K. R., Bennett L. L., Dillard T. A., Tellis C. J., Tenholder M. F. Overnight nasal CPAP improves hypersomnolence in sleep apnea. Chest. 1986 Aug;90(2):172–176. doi: 10.1378/chest.90.2.172. [DOI] [PubMed] [Google Scholar]
  48. Remmers J. E., deGroot W. J., Sauerland E. K., Anch A. M. Pathogenesis of upper airway occlusion during sleep. J Appl Physiol Respir Environ Exerc Physiol. 1978 Jun;44(6):931–938. doi: 10.1152/jappl.1978.44.6.931. [DOI] [PubMed] [Google Scholar]
  49. Riley R. W., Powell N. B., Guilleminault C. Inferior sagittal osteotomy of the mandible with hyoid myotomy-suspension: a new procedure for obstructive sleep apnea. Otolaryngol Head Neck Surg. 1986 Jun;94(5):589–593. doi: 10.1177/019459988609400510. [DOI] [PubMed] [Google Scholar]
  50. Riley R. W., Powell N. B., Guilleminault C., Nino-Murcia G. Maxillary, mandibular, and hyoid advancement: an alternative to tracheostomy in obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 1986 Jun;94(5):584–588. doi: 10.1177/019459988609400509. [DOI] [PubMed] [Google Scholar]
  51. Riley R., Guilleminault C., Powell N., Simmons F. B. Palatopharyngoplasty failure, cephalometric roentgenograms, and obstructive sleep apnea. Otolaryngol Head Neck Surg. 1985 Apr;93(2):240–244. doi: 10.1177/019459988509300222. [DOI] [PubMed] [Google Scholar]
  52. Sanders M. H., Gruendl C. A., Rogers R. M. Patient compliance with nasal CPAP therapy for sleep apnea. Chest. 1986 Sep;90(3):330–333. doi: 10.1378/chest.90.3.330. [DOI] [PubMed] [Google Scholar]
  53. Sanders M. H. Nasal CPAP effect on patterns of sleep apnea. Chest. 1984 Dec;86(6):839–844. doi: 10.1378/chest.86.6.839. [DOI] [PubMed] [Google Scholar]
  54. Schmidt H. S., Clark R. W., Hyman P. R. Protriptyline: an effective agent in the treatment of the narcolepsy-cataplexy syndrome and hypersomnia. Am J Psychiatry. 1977 Feb;134(2):183–185. doi: 10.1176/ajp.134.2.183. [DOI] [PubMed] [Google Scholar]
  55. Sher A. E., Thorpy M. J., Shprintzen R. J., Spielman A. J., Burack B., McGregor P. A. Predictive value of Müller maneuver in selection of patients for uvulopalatopharyngoplasty. Laryngoscope. 1985 Dec;95(12):1483–1487. doi: 10.1288/00005537-198512000-00009. [DOI] [PubMed] [Google Scholar]
  56. Simmons F. B., Guilleminault C., Silvestri R. Snoring, and some obstructive sleep apnea, can be cured by oropharyngeal surgery. Arch Otolaryngol. 1983 Aug;109(8):503–507. doi: 10.1001/archotol.1983.00800220009003. [DOI] [PubMed] [Google Scholar]
  57. Smith P. L., Gold A. R., Meyers D. A., Haponik E. F., Bleecker E. R. Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med. 1985 Dec;103(6 ):850–855. doi: 10.7326/0003-4819-103-6-850. [DOI] [PubMed] [Google Scholar]
  58. Smith P. L., Haponik E. F., Allen R. P., Bleecker E. R. The effects of protriptyline in sleep-disordered breathing. Am Rev Respir Dis. 1983 Jan;127(1):8–13. doi: 10.1164/arrd.1983.127.1.8. [DOI] [PubMed] [Google Scholar]
  59. Smith P. L., Haponik E. F., Bleecker E. R. The effects of oxygen in patients with sleep apnea. Am Rev Respir Dis. 1984 Dec;130(6):958–963. doi: 10.1164/arrd.1984.130.6.958. [DOI] [PubMed] [Google Scholar]
  60. Soll B. A., George P. T. Treatment of obstructive sleep apnea with a nocturnal airway-patency appliance. N Engl J Med. 1985 Aug 8;313(6):386–387. doi: 10.1056/NEJM198508083130612. [DOI] [PubMed] [Google Scholar]
  61. Strohl K. P., Cherniack N. S., Gothe B. Physiologic basis of therapy for sleep apnea. Am Rev Respir Dis. 1986 Oct;134(4):791–802. doi: 10.1164/arrd.1986.134.4.791. [DOI] [PubMed] [Google Scholar]
  62. Strohl K. P., Hensley M. J., Saunders N. A., Scharf S. M., Brown R., Ingram R. H., Jr Progesterone administration and progressive sleep apneas. JAMA. 1981 Mar 27;245(12):1230–1232. [PubMed] [Google Scholar]
  63. Sullivan C. E., Issa F. G., Berthon-Jones M., Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981 Apr 18;1(8225):862–865. doi: 10.1016/s0140-6736(81)92140-1. [DOI] [PubMed] [Google Scholar]
  64. Sullivan C. E., Issa F. G., Berthon-Jones M., McCauley V. B., Costas L. J. Home treatment of obstructive sleep apnoea with continuous positive airway pressure applied through a nose-mask. Bull Eur Physiopathol Respir. 1984 Jan-Feb;20(1):49–54. [PubMed] [Google Scholar]
  65. Sullivan C. E., Issa F. G. Obstructive sleep apnea. Clin Chest Med. 1985 Dec;6(4):633–650. [PubMed] [Google Scholar]
  66. Suratt P. M., Dee P., Atkinson R. L., Armstrong P., Wilhoit S. C. Fluoroscopic and computed tomographic features of the pharyngeal airway in obstructive sleep apnea. Am Rev Respir Dis. 1983 Apr;127(4):487–492. doi: 10.1164/arrd.1983.127.4.487. [DOI] [PubMed] [Google Scholar]
  67. Sutton F. D., Jr, Zwillich C. W., Creagh C. E., Pierson D. J., Weil J. V. Progesterone for outpatient treatment of Pickwickian syndrome. Ann Intern Med. 1975 Oct;83(4):476–479. doi: 10.7326/0003-4819-83-4-476. [DOI] [PubMed] [Google Scholar]
  68. Thawley S. E. Surgical treatment of obstructive sleep apnea. Med Clin North Am. 1985 Nov;69(6):1337–1358. doi: 10.1016/s0025-7125(16)30990-7. [DOI] [PubMed] [Google Scholar]
  69. Victor D. W., Jr, Sarmiento C. F., Yanta M., Halverson J. D. Obstructive sleep apnea in the morbidly obese. An indication for gastric bypass. Arch Surg. 1984 Aug;119(8):970–972. doi: 10.1001/archsurg.1984.01390200086020. [DOI] [PubMed] [Google Scholar]
  70. Walsh R. E., Michaelson E. D., Harkleroad L. E., Zighelboim A., Sackner M. A. Upper airway obstruction in obese patients with sleep disturbance and somnolence. Ann Intern Med. 1972 Feb;76(2):185–192. doi: 10.7326/0003-4819-76-2-185. [DOI] [PubMed] [Google Scholar]
  71. Weitzman E. D., Kahn E., Pollak C. P. Quantitative analysis of sleep and sleep apnea before and after tracheostomy in patients with the hypersomnia-sleep apnea syndrome. Sleep. 1980;3(3-4):407–423. doi: 10.1093/sleep/3.3-4.407. [DOI] [PubMed] [Google Scholar]
  72. Wilhoit S. C., Brown E. D., Suratt P. M. Treatment of obstructive sleep apnea with continuous nasal airflow delivered through nasal prongs. Chest. 1984 Feb;85(2):170–173. doi: 10.1378/chest.85.2.170. [DOI] [PubMed] [Google Scholar]

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