Obstructive sleep apnea: 
an overview of treatments

This activity is provided by Haymarket Medical Education (HME) for physician credit.

This activity is co-provided by Medical Education Resources (MER) for nursing contact hours.

Faculty
Susan Collazo, RN, MSN, APN-CNP
Thoracic surgery nurse practitioner
Northwestern Memorial Hospital
Chicago, Ill.

Release Date: December 10, 2014
Expiration Date: December 9, 2015
Estimated time to complete the educational activity: 30 minutes

Statement of Need: Obstructive sleep apnea (OSA), which has been associated with increased health-care utilization, is becoming more prevalent with rising obesity rates. OSA has been undertreated or mistreated in primary care, despite the availability of effective therapies. By familiarizing themselves with these treatments, primary-care providers can reduce the burden of OSA for individual patients and the health-care system as a whole.

Target Audience: This activity has been designed to meet the educational needs of primary-care health-care professionals who will treat persons presenting with symptoms of obstructive sleep apnea.

Learning Objectives: After completing the activity, the participant should be better able to:

• Identify the primary and adjunctive therapies for obstructive sleep apnea
• Explain the benefits, risks, and/or contraindications of the various treatments
• Evaluate the effectiveness of a chosen treatment
• Revise treatment plans as needed based on patient response to therapy

Accreditation Statements

Physician Credit: HME is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical ­education for physicians.

Credit Designation: HME designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit<sup?tm ^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. </sup?tm

Nursing Credit: MER is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Credit Designation: This CE activity provides 0.5 contact hour ofcontinuing nursing education.MER is a provider of continuing nursing education by the California Board of Registered Nursing, Provider #CEP 12299, for 0.5 contact hour. 

This activity qualifies for 0.25 pharmacotherapy credit.

American Academy of Physician Assistants (AAPA)

The AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a ­maximum of 0.5 hour of Category I credit for completing this program.

Disclosure Policy

In accordance with the ACCME Standards for Commercial Support, HME requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. HME resolves all conflicts of interest in an effort to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.

Furthermore, HME seeks to verify that all scientific research referred to, reported, or used in a CME/CE activity conforms to the generally accepted standards of experimental design, data collection, and analysis. HME is ­committed to providing its learners with high-quality CME/CE activities that promote improvements in health care and not those of a commercial interest.

The faculty reported the following financial relationships withcommercial interests whose products or services may be mentioned inthis CME/CE activity:

Faculty Disclosures

Name of Faculty	Financial Relationship
Susan Collazo, RN, MSN, APN-CNP	No relevant financial relationships

Staff/Planners’ Disclosures

The planners and managers for this program reported the following ­financial relationships with commercial interests whose products or services may be related to the content of this CME activity:

HME planners and managers have no relevant financial relationships to disclose.

MER planners and managers have no relevant financial relationships to disclose.

Disclosure of Unlabeled Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. HME and MER do not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Method of Participation: There are no fees for participating in and receiving CME/CE credit for this activity. During the period of December 10, 2014, through December 9, 2015, participants must:

1. Read the learning objectives and faculty disclosures;
2. Study the educational activity;
3. Submit the post-test online (clinicians may register at www.mycme.com);
4. Complete the evaluation form online

A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.

Disclaimer: The content and views presented in this educational activityare those of the authors and do not necessarily reflect those of HME orMER. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. The information presented in this activity is not meant to serveas a guideline for patient management.

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HOW TO TAKE THE POST-TEST: Click here after reading the article to take the post-test on myCME.com.

The obesity epidemic has dramatically increased the prevalence of obstructive sleep apnea (OSA), which now affects approximately 60% of overweight persons (those with a body mass index, or BMI, ≥25 kg/m²).¹ The link between OSA and obesity is further strengthened by findings in which a 10% reduction in body weight was associated with a parallel 26% reduction in apnea-hypopnea index (AHI);² AHI is derived from the number of apneas and hypopneas during sleep divided by hours of sleep.


Not only is the OSA patient population growing, but persons with this sleep disorder, in which airways become narrowed or blocked during sleep so that breathing pauses, have been found to have a higher health-care utilization rate than those without such a diagnosis, particularly in the year of diagnosis.³ 


With these factors taken together, it may be unrealistic to expect sleep specialists alone to manage this increased caseload of potential OSA patients,⁴ and researchers have shown that a primary-care treatment model has comparable effectiveness to a sleep-specialist treatment model.⁵ Primary-care clinicians should therefore become familiar with the various treatment modalities for OSA so that they can appropriately manage each individual patient.


Patient scenario: Mr. W, a 45 year-old truck driver with a BMI of 35 kg/m², presents to your clinic with his wife. She reports that Mr. W snores and gasps during sleep—the most sensitive clinical indicators of possible obstructive sleep apnea (OSA). The patient himself notes that he has trouble staying awake while driving. Your physical examination of Mr. W reveals a crowded oropharyngeal airway, a neck size of 18 inches, and hypertension (Table 1). Because you believe that the patient is at high risk for OSA, you send him to a sleep center to undergo polysomnography (sleep study). When you get the results, you look for Mr. W’s AHI, with 5 to 14 breathing pauses per hour indicating mild OSA, 15 to 29 breathing pauses per hour indicating moderate OSA, and 30 or more breathing pauses per hour indicating severe OSA.⁶ Mr. W’s AHI was severely high at 105, with significant oxygen desaturation (hypoxia) of 75%. Both of these indicators support a diagnosis of OSA. What is the best treatment for Mr. W?


OSA should be approached as a chronic disease, requiring a multidisciplinary approach that covers medical, behavioral, and possible surgical options for proper treatment. The main goal of therapy is prevention or alleviation of upper-airway obstruction. 


Table 1: When to suspect obstructive sleep apnea (OSA)

Patient complains of daytime sleepiness.

Patient’s bed partner reports loud snoring by patient.

Patient is obese (BMI ≥30 kg/m2).

Physical examination reveals conditions that narrow the upper airway, such as a crowded pharynx with a low-lying uvula and soft palate.

Physical examination reveals large tonsils, a retrognathic mandible (overbite), and/or a neck circumference of more than 17 inches in men or more than 16 inches in women.

Child patient has enlarged tonsils and/or adenoids.

Patient has diabetes or prediabetes, conditions that render the person up to 3 times more likely than those in the general population to have OSA.

Patient has a history of congestive heart failure, atrial fibrillation, treatment-refractory hypertension, or pulmonary hypertension.

Adapted from Collazo S. Identifying obstructive sleep apnea. The Clinical Advisor. 2014;17(9):36-44.

From the December 01, 2014 Issue of Clinical Advisor