European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea

Author(s): Randerath W et al.

European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea - article image

European Respiratory Review Published online November 30, 2021 | https://thorax.bmj.com/content/76/10/989

Digest author(s): Johan Verbraecken | 19 January, 2022

Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have been refined or reconsidered. In this European Respiratory Society (ERS) guideline on non-CPAP therapies for OSA, recommendations are presented determined by a systematic review of the literature. It is as an update of the 2011 ERS Statement on non-CPAP therapies, advanced into a clinical guideline. A multidisciplinary group of experts, including pulmonary, surgical, dentistry and ear-nose-throat specialists, methodologists and patient representatives considered the most relevant clinical questions (for both clinicians and patients) relating to the management of OSA. Eight key clinical questions were generated, and a systematic review was conducted to identify published randomised clinical trials that answered these questions. PICO 4 was split in two separate PICOs. The GRADE approach was used to assess the quality of the evidence and the strength of recommendations. The resulting guideline addressed gastric bypass surgery, custom-made dual-block mandibular advancement device, hypoglossal nerve stimulation, myofunctional therapy, maxillo-mandibular osteotomy, carbonic anhydrase inhibitors, and positional therapy.

The final recommendations were as follows:

In adult patients with OSA …

Recommendation (all conditional)
Intervention or comparison

Certainty of evidence

PICO 1 (laparoscopic R-en-Y Gastric bypass surgery or diet)

FOR

Very low

PICO 2 (MAD or CPAP)

AGAINST

Low

PICO 3 (NXII stimulation or no treatment)

AGAINST

Very low

PICO 4a (MYOFUNCTIONAL therapy or no treatment)

FOR

Low

PICO 4b (MYOFUNCTIONAL therapy or CPAP)

AGAINST

Very low

PICO 5 (MAXILLO-MANDIBULAR OSTEOTOMY or CPAP)

FOR

Very low

PICO 6 (carbonic anhydrase inhibitor or placebo)

FOR

Low

PICO 7 (sleep position therapy or CPAP)

FOR

Very low

PICO 8 (sleep position therapy or MAD)

FOR

Very low

 

All recommendations were conditional for the intervention or the comparison (6 for, 3 against). The overall certainty of evidence was low to very low.

These recommendations can be used to benchmark quality of care for people with OSA across Europe and to improve outcomes.

Respiratory digests
Sleep and breathing disorders