Medical Management of Obstructive Sleep Apnea

폐쇄성 수면 무호흡증의 내과적 치료

Obstructive sleep apnea (OSA) is a prevalent disorder characterized by repeated episodes of obstructive apnea and hypopnea due to repetitive collapse of the upper airway during sleep. OSA should be suspected in patients that are obese, hypertensive, habitual snorers, and hypersomnolent. Standard overnight polysomnography is essential for proper diagnosis. OSA is a chronic disease that requires long-term multidisciplinary care. Management of this condition begins with patient education. Behavior modifications, such as weight loss, exercising, changing the sleep position, abstaining from alcohol, and avoiding certain medications, are essential for most patients with OSA. Positive airway pressure (PAP) is the mainstay therapy for OSA, and its initiation requires selection of an appropriate device and mode of PAP. The optimal pressure is determined by titration during the second polysomnography. Continuous positive airway pressure (CPAP) is the first-line therapy for moderate to severe OSA. Due to low compliance rates of CPAP, it is important to educate patients and manage complications associated with mask and pressure-related discomfort as early as possible. Bi-level PAP or auto-titrating PAP is an acceptable options for patients that cannot tolerate CPAP. In cases of mild to moderate OSA, an oral appliance can be used as a reasonable alternative therapy.