SLEEP-DISORDERED BREATHING DIAGNOSIS AND TREATMENTkapak

NON-SURGICAL NON-POSITIVE AIRWAY PRESSURE TREATMENTS IN OBSTRUCTIVE SLEEP APNEA SYNDROME

Nagihan Gülhan Yaşar

Ankara Bilkent City Hospital, Department of Otorhinolaryngology, Ankara, Türkiye

Gülhan Yaşar N. Non-Surgical Non-Positive Airway Pressure Treatments in Obstructive Sleep Apnea Syndrome. In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.111-117.

ABSTRACT

Non-surgical approaches in the treatment of obstructive sleep apnea syndrome (OSAS) play a significant role, particularly in individuals with mild to moderate disease severity. Within this scope, a variety of methods are available, including lifestyle modifications (cessation of smoking and alcohol consumption, weight control, and sleep hygiene), positional therapy, and oral appliances. Lifestyle changes should be recommended as the first step for all patients diagnosed with OSAS. Patients should be informed about sleep hygiene. Environmental controls, such as setting regular bedtimes, ensuring adequate sleep, and avoiding stimulants such as televisions and phones in the bedroom, should be recommended in addition to other treatments. Alcohol, tobacco, and sedative medications have been shown to have negative effects on OSAS. Regardless of the treatment prescribed, patients are advised to avoid these substances in addition. Some commonly used sedative medications have been shown to have significant effects on sleep patterns and apneas and hypopneas. OSAS patients using sedative medications should be evaluated by relevant medical specialists to determine whether their medication should be discontinued and, if so, the most appropriate medication to continue. The positive impact of weight loss on the disease is undeniable. While weight loss through diet can reduce the severity of the disease, complete resolution of the disease is generally not possible. Therefore, weight loss is not the sole treatment option but rather a complementary treatment to other treatment modalities. In addition to diet, weight loss through bariatric surgery also has positive effects in patients with appropriate indications. If the patient loses 10% or more of their weight, a new sleep study should be performed, and the treatment plan should be revised. Positional OSAS refers to the occurrence of apneas and hypopneas twice as often when sleeping in a supine position as when sleeping in another position. In patients with positional apnea, traditional techniques aimed at preventing supine sleep as well as modern vibratory devices have demonstrated significant improvements in the apnea-hypopnea index (AHI) and daytime sleepiness. Among oral appliances, mandibular advancement devices (MADs) are the most commonly used; they reduce apnea events by increasing upper airway patency and offer an effective alternative particularly for patients who are unable to tolerate continuous positive airway pressure (CPAP). When combined with appropriate patient selection and regular follow-up, these approaches are effective in alleviating OSAS symptoms and improving quality of life.

Keywords: Sleep apnea syndromes; Apnea; Body mass index; Obesity; Therapy

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