Therapeutic alternatives to PAP therapy in patients with PAP nonadherence: a retrospective monocentric observational study

Positive airway pressure (PAP) ventilation is the gold standard for the treatment of obstructive sleep apnoea. Despite treatment effectiveness, compliance is poor. On average, about 50% of patients use the therapy for less than 4 hours per night. This results in increased cardiovascular risk and daytime sleepiness. The demand for alternative therapies is increasing among patients and practitioners. In the period from 2015 to 2021, 230 patients with PAP nonadherence were followed up in an observational study at the ENT clinic of the University Hospital Jena. 54 patients between 27 and 81 years (Y) [mean± standard deviation 60.9±10.7 Y; m 33, w 21] with a baseline apnoea-hypopnoea index (AHI) between 12/h and 81/h [35±17/h] were analysed. All patients received polysomnography and 37 patients received drug-induced sleep endoscopy, which were evaluated according to the Vote classification. 44 patients were suitable for one (18 patients) or more (26 patients) alternative therapies. In 10 patients there was no alternative therapies due to anatomical conditions and secondary diseases. The conservative alternative therapies mandibular advancement splint (12 patients) and weight reduction (8 patients) predominated. Surgical alternative therapies (hypoglossal stimulator, uvulapalatopharyngoplasty, tongue base resection) were performed in 3 patients each. 27 patients were not treated due to patient request and anatomy. The average AHI was reduced from 35.6/h to 23.9/h in the patients treated with alternative therapies. With increasing prevalence of PAP nonadherence , individualised therapy is essential for effective care. The use of several alternative therapies , if necessary in combination, is necessary for a sufficient reduction of the AHI and an increase in quality of life.

Publication History

Article published online:
12 May 2023