Sleep apnea is a disorder in which an individual has pauses in breathing during sleep. These pauses may last from seconds to one full minute, and may occur hundreds of times during the night. Untreated, sleep apnea can increase the risk of, or worsen, several different types of heart disease.
The most common type of sleep apnea is obstructive sleep apnea (OSA). Although obstructive sleep apnea may occur in children with enlarged tonsils, the main population suffering from this disorder are the overweight. On September 24, 2013, the American College of Physicians published a review of the existing medical literature regarding sleep apnea, and concluded that the first line of defense against this disorder among the overweight and the obese is weight loss. Second- and third-line therapies include continuous positive airway pressure (CPAP) devices and mandibular advancement devices (MADs).
"Evidence shows that OSA rates are increasing, and this is probably because of escalating obesity rates," the ACP observes. In the past, CPAP devices were the first-line therapy, but adherence to the recommended usage of these machines is sub-optimal, in part because of the discomfort of wearing them. Additionally, there have been no randomized controlled trials (RCTs) comparing mortality among CPAP users and non-users. Generally, drug trials for OSA have been inconclusive; surgical treatments also have little evidentiary support for their use over control treatments.
CPAP machines use mild pressure to keep a person's breathing airway open. There are a variety of CPAP treatments, including oral, nasal, bilevel, and fixed. MADs, also known as mandibular splints, are worn in the mouth during sleep. Wearing an MAD moves the lower jaw forward, which tightens the muscles and soft tissue of the upper airway and makes obstruction less likely. Research comparing CPAP to MADs is limited, but generally shows greater effectiveness for CPAP and slightly better adherence for MADs.