Clinical trials
The evidence base for non-surgical and surgical management is limited, because only a few long-term RCTs comparing techniques exist.
A Cochrane review was only able to identify 12 studies for surgical intervention in OSAHS.10 The heterogeneity of the data prevented pooled analysis; however, the number of RCTs is increasing and evidence is emerging.
A recent RCT by a Stockholm group has demonstrated that low-calorie diet modification in obese men with severe obstructive sleep apnoea can reduce the AHI.11 Five out of the 30 patients were disease free after nine weeks, with the remainder improving from severe OSAHS to mild OSAHS.
A further large RCT demonstrated significant improvement after one year, especially in those with a high AHI and those who lost more than 10kg in weight.12 Longer-term studies are required but this evidence is compelling.
Guidelines
- NICE. Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. TA139. London, NICE, 2008.
These guidelines recommend the use of CPAP for moderate to severe OSAHS because several RCTs have demonstrated an improvement in patients' ESS and levels of daytime sleepiness.
Comparison with dental devices did not conclude one was more effective than the other with regard to the ESS; however, CPAP led to a greater improvement in the AHI.
- SIGN. Management of obstructive sleep apnoea/hypopnoea syndrome in adults. Guideline 73, 2003.
Curriculum
This topic is covered in the GP curriculum in statement 15.8: Respiratory problems
More online
- The British Snoring and Sleep Apnoea Association website provides very useful information for patients and partners. www.britishsnoring.co.uk
- Obstructive sleep apnoea and driving guidelines are available from the DVLA. www.direct.gov.uk/en/Motoring/DriverLicensing/MedicalRulesForDrivers
