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Diagnosis and Treatment of Obstructive Sleep Apnea in Adults

Slide: 31 of 32

Knowledge Gaps and Future Research Needs

Current studies have not adequately evaluated long-term clinical outcomes. The effectiveness of treatment is based on intermediate measures such as sleepiness and apnea-hypopnea index. However, trial evidence is lacking to determine whether improving sleep-study measures has any affect on mortality or comorbities. There is insufficient clinical trial evidence to evaluate the effectiveness of many obstructive sleep apnea (OSA) treatments, including surgery. However, it is difficult to interpret surgical studies, because patients being considered for surgery are often not comparable to those being considered for nonsurgical treatments. Among seven clinical trials, four found surgery to be an effective treatment for OSA (vs. no treatment), but three found no improvement in OSA measures or outcomes. Studies evaluating surgery versus other treatment options were similarly heterogeneous. No studies use subgroup analysis in evaluating the effectiveness of treatments. Patient adherence is a major problem inhibiting the effectiveness of continuous positive airway pressure treatment, but the relative compliance rates with mandibular advancement devices or other treatment interventions have not been evaluated.