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Treatment of sleep-disordered breathing

Book Contribution - Chapter

This chapter deals with different therapeutic approaches to medical conditions caused by sleep-disordered breathing. General recommendations and conservative measures are important first steps in the management of sleep-disordered breathing. Pharmacological agents have no major role in the treatment of obstructive sleep apnoea but are subject to renewed interest in contemporary clinical research. Some medications may be helpful in the treatment of central sleep apnoea, especially in patients suffering from heart failure. Treatment with oral devices has become a cornerstone in the management of patients with mild to moderate obstructive sleep apnoea and may also be indicated in selected patients with severe disease. Positive airway pressure continues to be the mainstay of treatment of obstructive sleep apnoea patients with moderate to severe disease. Bilevel positive airway pressure is mainly indicated as a therapy for respiratory failure (alveolar hypoventilation with hypercapnia) but not for treating patients with obstructive or central sleep apnoea. Adaptive servo-ventilation has been introduced as a specific treatment of cardiac patients with central sleep apnoea and Cheyne-Stokes respiration, but may also be used in other conditions associated with central sleep apnoea. Heart failure with an ejection fraction less than 45% is a contraindication for this treatment. Surgery of the upper airways or of the maxillomandibular skeleton may be indicated in selected patients with obstructive sleep apnoea. Bariatric surgery is restricted to morbidly obese patients with severe obstructive sleep apnoea who fail to lose weight with conservative measures such as hypocaloric diet and exercise training.
Book: Sleep medicine textbook
Edition: 2
Pages: 357 - 378
ISBN:9781119789017
Publication year:2021
Accessibility:Closed