The American College of Physicians (ACP) has officially recommended weight loss and CPAP (in combination) as the first line of defense against obstructive sleep apnea. The information is not exactly news to sleep physicians, but industry advocates see it as another sign that sleep apnea treatment is firmly within the mainstream.
As a sign of the growing influence of oral appliances, the ACP also recommended a mandibular advancement device (MAD) as an alternative therapy for patients who prefer it, for those who do not comply with CPAP treatment.
“The evidence shows that a mandibular advancement device can effectively improve sleep study results and sleepiness,” said Molly Cooke, MD, FACP, president, ACP. “However, CPAP more effectively raised the minimum oxygen saturation compared to MAD.”
The new recommendations were published in the Annals of Internal Medicine, as well as in an ACP press release. The ACP reports that more than 18 million American adults have sleep apnea, which increases the risk of high blood pressure, heart attack, stroke, heart failure, and diabetes and increases the chance of driving or other accidents. Sleep apnea is also identified as a leading cause of excessive daytime sleepiness.
“Obesity is a risk factor for obstructive sleep apnea and the evidence indicates that intensive weight loss interventions help improve sleep study results and symptoms of OSA,” said Cooke, who is also a member of ACP’s Clinical Guidelines Committee. “Plus, losing extra weight is associated with many other health benefits.”
ACP’s guideline is titled Management of Obstructive Sleep Apnea in Adults and includes advice to help physicians practice high value care. “Physicians should stress the importance of compliance with treatments, especially CPAP,” said Cooke. “Doctors should weigh patient preferences and the likelihood of therapy adherence against costs before initiating CPAP treatment.”
ACP officials characterized the available evidence for treating OSA with surgery as “limited,” noting that it is associated with serious adverse events and “should not be used as initial treatment.”