Title
How to treat patients that do not tolerate continuous positive airway pressure How to treat patients that do not tolerate continuous positive airway pressure
Author
Faculty/Department
Faculty of Medicine and Health Sciences
Publication type
article
Publication
Sheffield ,
Subject
Human medicine
Source (journal)
Breathe : the respiratory professionel's source for continuing medical education. - Sheffield, 2004, currens
Volume/pages
7(2010) :2 , p. 157-167
ISSN
1810-6838
2073-4735
Carrier
E
Target language
English (eng)
Affiliation
University of Antwerp
Abstract
The effectiveness of continuous positive airway pressure (CPAP) is potentially high for the treatment of obstructive sleep apnoea/hypopnoea syndrome (OSAHS), but accounting for the relatively low acceptance and compliance, and correcting for sleep time, its actual effect and use, the adjusted CPAP effectiveness remains relatively low. Oral appliance therapy has emerged as a noninvasive alternative to CPAP in subjects with OSAHS who do not tolerate or comply with CPAP. Surgical procedures can be performed successfully in carefully selected patients. Moreover, concerning the surgical treatment options, it appears from the available evidence that maxillomandibular advancement is a safe and highly effective surgical treatment modality for OSAHS that should be indicated more readily in clinical practice. Two methods of pre-treatment airway evaluation will be discussed. First, newer technologies using imaging techniques coupled with computational fluid dynamics methods allow investigation of the flow characteristics and aerodynamic forces within the upper airway of the OSAHS patient. Secondly, routine application of drug-induced sleep endoscopy to assess the site(s) of flutter and upper airway obstruction during druginduced sleep can increase the success rate of both upper airway surgery and oral appliance therapy.
Handle