Adjunct Therapies for Obstructive Sleep Apnea

Introduction to Adjunct Therapies

The American Academy of Sleep Medicine recommends weight loss, positional therapy, and avoidance of alcohol and sedatives before bedtime as primary adjunct therapies for the treatment of obstructive sleep apnea 1, 2

Weight loss should be recommended for all overweight OSA patients using oral appliances, as successful dietary weight loss may improve the Apnea-Hypopnea Index (AHI) in obese patients with OSA 1, 3
Positional therapy is an effective secondary therapy for patients who have a lower AHI in non-supine versus supine positions 1, 3
Avoidance of alcohol and sedatives before bedtime is essential as these substances can worsen OSA by reducing upper airway muscle tone 1, 2
Exercise can complement oral appliance therapy by improving overall sleep quality and potentially reducing OSA severity 1, 4

A positioning device such as an alarm, pillow, backpack, or tennis ball should be used when initiating positional therapy 1
To establish efficacy of a positioning device at home, providers should consider using an objective position monitor 1
Correction of OSA by position should be documented with polysomnography before initiating this form of treatment as a primary therapy 1

Self-reported compliance, objective position monitoring, side effects, and symptom resolution should be assessed for positional therapy 1
After substantial weight loss (10% or more of body weight), a follow-up polysomnography is indicated to determine if oral appliance adjustments are necessary 1
Regular follow-up with both a qualified dentist and sleep physician is essential to monitor the efficacy of both the oral appliance and adjunct therapies 5, 6

For patients with residual excessive daytime sleepiness despite effective oral appliance therapy, modafinil or armodafinil may be considered 4
Before considering pharmacologic options, clinicians must rule out suboptimal oral appliance adherence, insufficient sleep, poor sleep hygiene, other sleep disorders, and depression 4

Myofunctional therapy may be considered as an adjunctive treatment to oral appliance therapy for OSA 7, 8
This therapy focuses on exercises that target the tongue, soft palate, and lateral pharyngeal walls to improve muscle tone and function 8

Custom, titratable oral appliances are more effective than non-custom devices and should be the preferred choice when implementing adjunct therapies 9, 8
A multidisciplinary approach involving sleep physicians and qualified dentists is essential for optimal outcomes when combining oral appliances with adjunct therapies 7, 8
Follow-up sleep testing is necessary to confirm the efficacy of both the oral appliance and adjunct therapies 6

Relying solely on subjective improvement in symptoms is insufficient; objective assessment through sleep testing is necessary to confirm treatment efficacy 6
Initial side effects of oral appliances may reduce adherence and should be addressed promptly 8
Long-term dental changes can occur with oral appliance use, necessitating regular follow-up with a qualified dentist 10, 8