Managing obstructive sleep apnea : a comparison between continuous positive airway pressure and oral appliances

Abstract

Overview of the topic: Obstructive Sleep Apnea (OSA) is a disorder characterised by partial or complete collapse of the airway leading to either apneas, hypopneas or both. OSA has an effect on multiple systems of the body causing increase in pulmonary and cardiac disorders, cerebrovascular disease and impaired neurocognitive function, leading to daytime sleepiness, causing an increases in motor vehicle accidents. Diagnosis for OSA is mainly acquired by an overnight polysomnogram. There are various treatment options however, in this dissertation the effects of OA and CPAP will be discussed. The research question: In persons with obstructive sleep apnea does Continuous Positive Airway Pressure, compared to Oral Appliances, offer a better quality of life? PICO Elements: The population (P) studied was patients with obstructive sleep apnea. The intervention (I) observed was continuous positive airway pressure therapy while the comparison (C) was oral appliance therapy. The desired outcome (O) was an improvement in quality of life. Method: The key elements of the PICO question were used as key terms to generate alternative terms. These key terms were combined using Boolean Operators along with limiters in order to narrow the search. These terms were combined and inserted in EBSCO and PubMed. Exclusion of irrelevant articles was done by the PRISMA 2009 checklist. The application of inclusion/exclusion criteria was applied to assess the eligibility of the articles. The Critical Appraisal Skills Programme (CASP) tool was used to critically appraise the articles. Results: A total of seven key studies were identified. Both treatments achieved significant improvement in the quality of life of patients and various studies highlighted the effects brought about on the results due to the severity of the condition. Moderate OSA patients showed better results by OA therapy, while severe OSA patients improved more by CPAP-therapy. Conclusion: Although a definitive conclusion cannot be brought about, from the evidence gathered, one can conclude that either treatment is better than no treatment. Both therapies may bring about AE therefore it is important to provide a holistic care in order to seek the most appropriate therapy for the patients individually. Implications and recommendations: Early OSA treatment decreases the risk of compilations. Therefore, it is important to promote education and awareness to the general public as well as health care professionals (HCP). Management needs to establish guidelines for practise and more research by using larger samples for subgrouping of severity of condition required for a better understanding.