Agency News and Notes

Nighttime-breathing treatments backed by strongest evidence among options to treat sleep apnea

Among the treatments for obstructive sleep apnea, the effectiveness of a nighttime-breathing machine, the continuous positive airway pressure (CPAP) machine, was backed by the strongest evidence, and a mouthpiece worn at night was also shown to be effective, according to a new report funded by the Agency for Healthcare Research and Quality (AHRQ).

Sleep apnea is a disorder that disrupts sleep for an estimated 12 million Americans, with millions more likely undiagnosed. It causes people to stop breathing during sleep (from a few times per hour to every few minutes) due to the repeated collapse and blockage of the upper airway during sleep. The report found that the CPAP, which pumps air through a mask while the patient is asleep, is highly effective in improving sleep and related symptoms of obstructive sleep apnea by improving airflow. Another treatment, a mouthpiece called a mandibular advancement device, can also be very effective, the report found.

Weight loss and surgery to clear the airway blockage may also be effective, although the evidence behind these treatments is not as strong, according to the report, a comparative effectiveness review prepared by the Tufts Medical Center Evidence-based Practice Center for AHRQ's Effective Health Care Program. The report does note that all treatments have possible side effects.

To highlight the findings of the report, AHRQ also published guides for consumers and clinicians that summarize the latest evidence for treating obstructive sleep apnea, a disorder that can lead to heart disease, diabetes, and multiple other health problems. The report and the companion guides are available at http://www.effectivehealthcare.ahrq.gov.

"Obstructive sleep apnea is a frustrating and debilitating condition for so many Americans, and millions of people don't even know they have it. The resultant poor sleep and daytime sleepiness can lead to work-related or driving accidents," said AHRQ Director Carolyn M. Clancy, M.D. "These guides and this new report will help patients and their doctors understand what treatment options might be best for them."

The companion guides summarize the report's findings for consumers and clinicians. The consumer guide defines sleep apnea for patients and their families, summarizes treatment options, offers a list of questions to discuss with a doctor and contains basic cost information. The clinician guide covers these topics, provides "confidence ratings" for existing scientific evidence and offers a "clinical bottom line" to give clinicians tools to discuss treatment options with their patients.

The report, Comparative Effectiveness Review of the Diagnosis and Treatment of Obstructive Sleep Apnea in Adults, is the latest comparative effectiveness review from AHRQ's Effective Health Care Program. More information about the program can be found at http://www.effectivehealthcare.ahrq.gov.

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