Economic evaluation of CPAP therapy for obstructive sleep apnea: a scoping review and evidence map.

PURPOSE: To synthesize findings of economic evaluations investigating cost-effectiveness of continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) and of strategies of organization of care related to CPAP therapy. METHODS: Scoping review with searches conducted in MEDLINE, CRD, LILACS, and Embase in August 2020. Eligible studies were economic evaluations comparing CPAP to other alternative or assessing strategies of care for CPAP therapy. Results were presented narratively, and incremental cost-effectiveness ratios (ICER) were presented in evidence maps. RESULTS: Of 34 studies, 3 concluded that CPAP is less costly and more effective when compared to usual care. Most studies indicated that CPAP is associated with better health outcomes, but at higher prices. ICER ranged from USD 316 to 98,793 per quality-adjusted life years (QALY) gained (median 16,499; IQR 8267 to 33,119). One study concluded that CPAP is more costly and less effective, when treatment is applied to all patients, regardless of disease severity. Variability of ICER was mainly due to definition of population and applied time horizons. When CPAP was compared to mandibular advancement device, ICER ranged from USD 21,153 to 361,028 (median 89,671; IQR 26,829 to 295,983), which represents the investment in CPAP therapy required to obtain one extra QALY. Three studies assessed the effects of organizing CPAP therapy in primary care, which was cost-effective or cost-saving. CONCLUSIONS: Compared to usual care, CPAP is cost-effective after the second year of treatment, when indicated for moderate-to-severe OSA. CPAP therapy may be even more cost-effective by using different strategies of organization of care. These findings may inform decision making related to CPAP reimbursement in health systems. CLINICAL TRIAL REGISTRATION NUMBER: Not applicable.

Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome.

RATIONALE: Upper airway muscle function plays a major role in maintenance of the upper airway patency and contributes to the genesis of obstructive sleep apnea syndrome (OSAS). Preliminary results suggested that oropharyngeal exercises derived from speech therapy may be an effective treatment option for patients with moderate OSAS. OBJECTIVES: To determine the impact of oropharyngeal exercises in patients with moderate OSAS. METHODS: Thirty-one patients with moderate OSAS were randomized to 3 months of daily ( approximately 30 min) sham therapy (n = 15, control) or a set of oropharyngeal exercises (n = 16), consisting of exercises involving the tongue, soft palate, and lateral pharyngeal wall. MEASUREMENTS AND MAIN RESULTS: Anthropometric measurements, snoring frequency (range 0-4), intensity (1-3), Epworth daytime sleepiness (0-24) and Pittsburgh sleep quality (0-21) questionnaires, and full polysomnography were performed at baseline and at study conclusion. Body mass index and abdominal circumference of the entire group were 30.3 +/- 3.4 kg/m(2) and 101.4 +/- 9.0 cm, respectively, and did not change significantly over the study period. No significant change occurred in the control group in all variables. In contrast, patients randomized to oropharyngeal exercises had a significant decrease (P < 0.05) in neck circumference (39.6 +/- 3.6 vs. 38.5 +/- 4.0 cm), snoring frequency (4 [4-4] vs. 3 [1.5-3.5]), snoring intensity (3 [3-4] vs. 1 [1-2]), daytime sleepiness (14 +/- 5 vs. 8 +/- 6), sleep quality score (10.2 +/- 3.7 vs. 6.9 +/- 2.5), and OSAS severity (apnea-hypopnea index, 22.4 +/- 4.8 vs. 13.7 +/- 8.5 events/h). Changes in neck circumference correlated inversely with changes in apnea-hypopnea index (r = 0.59; P < 0.001). CONCLUSIONS: Oropharyngeal exercises significantly reduce OSAS severity and symptoms and represent a promising treatment for moderate OSAS. Clinical trial registered with www.clinicaltrials.gov (NCT 00660777).

Tratamento da apneia obstrutiva do sono / Obstructive Sleep Apnea Treatment

A Apneia Obstrutiva do Sono é uma morbidade de alta prevalência e com diversas consequências cardiovasculares. Atualmente, existem várias formas de tratamento, sendo a pressão positiva contínua de vias aéreas superiores (CPAP) a principal delas, especialmente para casos sintomáticos e as formas mais graves. No entanto, outras formas de tratamento estão disponíveis para formas mais leves deste distúrbio do sono, tais como: perda de peso, dispositivos de avanço mandibular, exercícios orofaríngeos e procedimentos cirúrgicos. Cada uma dessas modalidades tem encontrado seu espaço no tratamento da Apneia Obstrutiva do Sono, sendo fundamental a participação de uma equipe multidisciplinar para a escolha do melhor tratamento. Esse artigo de revisão do tratamento da Apneia Obstrutiva do Sono tem como foco o benefício cardiovascular associado ao tratamento deste importante e prevalente distúrbio respiratório do sono.

The Obstructive Sleep Apnea is a highly prevalent condition with several cardiovascular consequences. Currently, there are several forms of treatment. Continuous positive airway pressure (CPAP) is the main one, especially for symptomatic cases and more severe forms of Obstructive Sleep Apnea. However, other forms of treatment for Obstructive Sleep Apnea are available for milder forms of this sleep-disordered breathing such as weight loss, mandibular advancement devices, oropharyngeal exercises and surgical procedures. Each of these modalities has found indications in the treatment of Obstructive Sleep Apnea. In this scenario, it is fundamental toa multidisciplinary team to choose the best treatment. This review article addresses the treatment of Obstructive Sleep Apnea focusing on the cardiovascular benefit associated with treatment of this important and prevalent sleep-disordered breathing.