The quest for more comfortable and effective sleep apnea treatments is ongoing. We spoke to Dr. David White—widely regarded as one of the most influential sleep apnea treatment experts in the world today. A professor at Harvard Medical School and former president of the American Academy of Sleep Medicine, Dr. White is currently the chief medical officer at a major manufacturer of sleep apnea treatments. We asked him about new directions in the field, and what technologies are unfolding to improve the lives of patients.
There has been no major change in the way sleep apnea is diagnosed in quite some time. Though the techniques used are not new, the drive to identify patients with sleep apnea and treat them has steadily increased, based primarily on the accumulating evidence suggesting a relationship between OSA and adverse cardiovascular outcomes (strokes, heart attacks, and death). However, there are still no completed, randomized, controlled clinical trials definitively demonstrating that the treatment of OSA yields improved cardiovascular outcomes.
Similarly, in the area of OSA treatment, no new therapies that are widely accepted have been introduced in the last 10-20 years. CPAP devices are considerably smaller, quieter, better humidified, and deliver pressure in novel ways, but do not function greatly differently from those manufactured in the 1980s.
On the other hand, the CPAP masks are considerably better than previously and may be responsible for the modest gains in CPAP compliance that have been achieved over the last few decades. Dental appliances have also improved, but still generally advance the mandible with moderate success in OSA treatment. Finally, the upper airway surgical procedures continue to evolve. However, short of a major procedure, success remains limited and relatively few such procedures are done annually in the US. That being said, there are some new therapies on the horizon that may allow apnea patient more options.
The therapies described above will continue to evolve with better acceptance and adherence, but will not likely greatly