Obstructive Sleep Apnea Syndrome: Therapy

General measures

  • Positional therapy: sleeping preferably in the lateral position! (Essential component of non-positive pressure therapy for mild to moderate positional obstructive sleep apnea (OSA)).
    • If necessary, supine position prevention (RLV) against snoring (eg, anti-snoring vest).
  • Refrain from drinking alcohol in the evening! Generally limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Aim for normal weight! (Can be recommended to all patients with OSA!).
    • Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program.
    • Physical training; athletes snore – regardless of weight – less frequently than non-athletes.

    In male moderately overweight patients, a 10- to 15% weight reduction resulted in about a 50% reduction in apnea-hypopnea index (AHI)* .

  • Attention to sleep hygiene
  • Verification of fitness to drive:
    • For drivers of trucks, buses and vehicles for passenger transport (vehicles of group 2), daytime drowsiness must be excluded!
    • For drivers of cars and two-wheelers (vehicles of group 1), the same requirements apply (private decision).
  • Review of permanent medication due topossible effect on the existing disease: avoid sedating or relaxing drugs.
  • Avoidance of drugs:
    • Ecstasy (also XTC, Molly and others) – methylenedioxymethylamphetamine (MDMA); dosage on average 80 mg (1-700 mg); structurally belongs to the group of amphetamines.

* The apnea-hypopnea index (AHI) is used to diagnose and determine the severity of OSA.

Conventional nonsurgical therapy methods

  • Fitting a mask for nocturnal positive airway pressure (CPAP mask; cpap – continuous positive airway pressure; nasal continuous positive airway pressure breathing); this inflates the upper airway during inspiration so that there is no friction of the soft palate/ uvula against the posterior pharyngeal wall. [Standard therapy] The therapy leads to an improvement in quality of life as well as a positive influence on daytime sleepiness and also OSA-typical comorbidities.A meta-analysis of cohort studies was able to show that CPAP therapy was associated with a 42% lower risk of atrial fibrillation recurrences.
  • Mandibular advancement splints (synonyms: Mandibular advancement splint (UPS); snore therapy device; snore splint) are prescribed for sleep apnea syndrome when it is of low severity or the individual refuses CPAP positive pressure ventilation. This therapy system is prescribed by the physician in the sleep laboratory and fitted by the dentist. After an adjustment period of four to six weeks, the splint should be reviewed and any necessary adjustment should be made. Protrusion splints consist of two splint parts, one for the upper jaw and one for the lower jaw, and a hinged connection, which is also used to adjust the degree of protrusion (advancement of the lower jaw from the resting position). The following requirements for the use of a UPS should be met:
    1. Sufficient number of fixed and healthy teeth per jaw or, alternatively, a sufficient number of load-bearing implants.
    2. Sufficient ability to mouth opening
    3. Inconspicuous clinical functional analysis

    Tooth misalignment in healthy teeth as side effects could not be proven. However, dry mouth or increased salivation may occur as a result of snoring.

  • Cranial hypoglossal nerve stimulation of the upper airway (synonyms: electrical hypoglossal nerve stimulation (HNS); N. hypoglossus pacemaker; so-called “tongue pacemaker”; UAS = Upper Airway Stimulation); a sensor detects or analyzes the individual breaths of the patient and passes this information to a pulse generator.This takes a stimulation of the upper airway, preventing it from collapsing during breathing – therapy alternative for patients who fail CPAP therapy and mandibular advancement splints; approved therapy procedure by the Food and Drug Administration (FDA) in the U.S. for OSA patients (with BMI < 32 kg/m and established anteroposterior collapse, at velopharyngeal level).

Regular check-ups

  • Regular medical checkups

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
    • A total of 5 servings of fresh vegetables and fruit daily (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
    • Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grains, vegetables).
  • Observance of the following special dietary recommendations:
    • Diet rich in:
      • Minerals (magnesium)
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio training); athletes snore less often than non-athletes, regardless of weight.
  • Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.