The Sunday session State of the Art: What Is Next When CPAP Fails Your Patient With OSA (Obstructive Sleep Apnea) will highlight ways to improve therapy for sleep apnea, said Sunita Kumar, MD, FCCP, chair of the session. The session starts at 3:30 pm in room 386 of the convention center.

While continuous positive airway pressure (CPAP) is the most effective option for treating sleep apnea—it has treatment efficacy of nearly 100%—many patients struggle with using it effectively. During the session, attendees will hear from key experts on available alternatives to CPAP so they are better informed when they are discussing treatment options with their patients, and, thus, their patients can make a better-informed decision about their treatment.

“The most common reason for poor adherence to CPAP is lack of education on the impact of OSA—not just on sleep and daytime sleepiness but on other medical disorders such as diabetes, hypertension, abnormal heart rhythms, (arrhythmias), heart disease, and stroke,” said Dr. Kumar, professor of medicine in the division of pulmonary and critical care at Loyola University Medical Center. “Other [reasons] include timely (and early) follow-up with a sleep specialist/provider to address problems related to CPAP
adherence. Studies show that the pattern of CPAP use in the first month after therapy is started determines adherence at one year. Involvement of family members (spouse or significant other) also are associated with improved outcomes.”

Dr. Kumar and her co-presenters also will review mandibular advancement devices or oral appliances as alternatives to CPAP. A dentist specializing in sleep medicine typically fits them, she noted.

“Based on current recommendations, these can be considered for patients with mild to moderate sleep apnea as first line therapy,” Dr. Kumar said. “For those with severe sleep apnea, these can be considered if they are unable to tolerate CPAP.”

Hypoglossal nerve stimulation is another alternative treatment, she added. This is a surgical procedure performed by ENT and involves insertion of a lead in the hypoglossal nerve, which innervates the muscles of the upper airway. It can be considered in patients with moderate to severe OSA who have a BMI <34 and who do not have circumferential collapse of the upper airway on drug-induced sedation endoscopy.

“With recent innovations in these alternative therapies, such as titration of dental devices using a commercially available system (MATRx), it is possible to assess its treatment efficacy in the sleep lab,” Dr. Kumar explained. “Attendees will also hear of recent literature on the outcome of these treatments on other medical problems, such as hypertension similar to data that exists for CPAP.”