Study suggests a new way to treat sleep apnoea
A research team has examined shortcomings in responses to the continuous positive airway machine (CPAP) and found adding combinations of therapies gets results in those unable to tolerate CPAP.
The study by Professor Danny Eckert, Director at the Adelaide Institute for Sleep Health: Flinders Health and Medical Research Institute Sleep Health Research Program, was designed to control oral appliance therapy (OSA) in individuals who have an incomplete response to using only OAT, with the solution being to use additional targeted therapies informed by each individual’s specific causes of OSA known as “endotype” characterisation.
OSA endotypes were characterised pretherapy. Initially, an expiratory positive airway pressure (EPAP) valve and supine avoidance device therapy were added. Those with residual OSA then received one or more nonanatomical interventions based on endotype characterisation. Finally, if required, OAT was combined with EPAP and CPAP therapy.
“Rather than everyone first trying CPAP — for whom we know at least 50% will fail — we flipped the model on its head and gave everyone a dental split in the first instance,” Eckert explained. “However, we found that if the dental device alone was insufficient, we added extra treatments — and this combination of therapies fixed almost all the 50% of the remaining patients.
“We then added alternate and emerging therapies such as oxygen therapy, and novel medications informed by the findings of a detailed sleep study that we did which tells us exactly why each person gets their OSA.
“If this combination approach didn’t fully work, we then gave CPAP, but only as a last resort.”
Twenty participants completed the study, with OSA successfully controlled with combination in all but one participant (17 of 20 without CPAP). OAT plus EPAP and supine avoidance therapy treated OSA in 10 (50%) participants. OSA was controlled in five (25%) participants, one with the addition of O2 therapy, one with atomoxetine-oxybutynin and one requiring both. Two participants required CPAP for their OSA and another was CPAP intolerant.
Eckert explained that “using this new approach, we were able to treat almost all participants and only a few required CPAP” with findings suggesting the potential of precision medicine to information targets combination therapy to treat OSA.
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