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- Page navigation anchor for Treatment Options for Obstructive Sleep Apnea (OSA)Treatment Options for Obstructive Sleep Apnea (OSA)
I read with great interest the recent letters from Drs. Rotenberg and Pang, ENT Surgery proponents[1], and Dr. Cheryl Laratta and colleagues[2] who maintain the position that continuous positive air pressure (C-pap) remains the ‘Gold Standard’ and first choice of treatment for this ‘epidemic’ sleep disorder affecting approximately fifty percent of our over fifty population.
As the then Director of Member Services for the British Columbia Dental Association, in the Spring of 2013 I was tasked to review the proposed Standards and Guidelines of the B C College of Dental Surgeons for the prescribing, fabrication, fitting and titration of Mandibular Repositioning Appliances for the treatment of OSA. I quickly discovered that the proposed regulatory rules followed similar standards and guidelines being formulated by the College of Physicians and Surgeons of B C and as were also being formulated by a committee of the American Academies of Sleep Medicine and Dental Sleep Medicine. I urge all practicing physicians, surgeons and dentists to read the seminal, ten year review article published in the Journal of Clinical Sleep Medicine[3].
With some degree of OSA affecting twice the numbers of middle aged patients with Type II diabetes in our society, and not being adequately treated with either C-Pap (due to non-compliance) or surgical interventions (due to cost, morbidity, questionable long term success and other considerations), the option for a physician prescribed,...
Show MoreCompeting Interests: Provider of Mandibular Repositioning Appliance (Dr. Wayne Halstrom’s ‘Silencer’) for treatment of mild to moderate Obstructive Sleep Apnea - Page navigation anchor for RE: Diagnosis and treatment of obstructive sleep apnea in adultsRE: Diagnosis and treatment of obstructive sleep apnea in adults
We read with interest the responses to our recent review of the diagnosis and treatment of obstructive sleep apnea (OSA)[1]. We agree that challenges with current therapies for OSA necessitate the study of newer and personalized treatments to improve clinical outcomes, treatment adherence and patient satisfaction. As indicated by Dr. Pupko, the use of dronabinol in the treatment of OSA[2] is one of several such approaches to improve OSA severity and sleepiness. The PACE study demonstrated early but promising results of cannabimimetics, which should be validated through comparisons to established OSA treatments over a longer duration of follow-up in larger patient cohorts.
Highlighting the difficulties that some patients with OSA experience tolerating CPAP therapy, Drs. Rotenberg and Pang stress the importance of surgical treatments to improve patient outcomes. We did not find a strong body of high quality literature to justify the use of upper airway surgery as a first line treatment for OSA. Specifically, there is limited data on disease recurrence and the existing literature suggests that complications are not infrequent. Our conclusions are supported by a recent large meta-analysis by the Canadian Agency for Drugs and Technology for Health (CADTH), which also found insufficient evidence to support upper airway surgery as first line therapy for OSA except in highly selected patients for whom other therapies (CPAP or oral appliances) are intolerable or unacceptable...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Diagnosis and treatment of obstructive sleep apnea in adultsRE: Diagnosis and treatment of obstructive sleep apnea in adults
In light of the upcoming legalization of marijuana in this country, could the authors please comment on the use of marijuana and its pharmacological derivatives in the treatment of OSA? The recent PACE trial (1) looks promising.
Also, could the authors comment on the use of modafinil, as this medication is available for prescription by primary care practitioners to OSA patients complaining of excessive daytime sedation.
Thank you.
1) Sleep. 2018 Jan 1;41(1).Pharmacotherapy of Apnea by Cannabimimetic Enhancement, the PACE Clinical Trial: Effects of Dronabinol in Obstructive Sleep Apnea.
Carley DW, Prasad B, Reid KJ, Malkani R, Attarian H, Abbott SM, Vern B, Xie H, Yuan C, Zee PC.Competing Interests: None declared. - Page navigation anchor for CPAP and adherenceCPAP and adherence
Dear Editor,
I read with interest the piece by Laratta et al regarding diagnosis and treatment of OSA in adults. The authors are to be commended for the thoughtfulness of their work.
However, I am concerned by several important omissions from this piece. First, although the authors point about the strong historical advantages to CPAP, they surprisingly neglected to inform the readership of the dismal rate of long-term CPAP adherence, which has been well studied in large populations to be <50% after one year of prescription. This places the concept of CPAP as gold-standard for OSA therapy under some doubt. Secondly, in reference to surgery for sleep apnea, the authors only mention various older forms of surgery some of which have not been done for years. Surgery for sleep apnea has been studied extensively in recent years, since in parallel with the poor uptake of CPAP, patients are looking for more permanent solutions and thus techniques have been devised to improve surgical success. The modern scientific literature shows a number of far more advanced techniques than those the authors refer to that carry a success rate comparable to CPAP. Finally, no discussion on treatment can be had in the modern era without reference to value and cost, in which case once again contemporary data would suggest that surgery is comparable to CPAP.
In order to provide a balanced view and educate the readership on the modern state of treatment of OSA, this ar...
Show MoreCompeting Interests: None declared.