NICE guidance - treatments for mild OSAHS (obstructive sleep apnoea/hypopnoea syndrome)

Treatments for mild OSAHS (obstructive sleep apnoea/hypopnoea syndrome)

Use the results of the sleep study to diagnose OSAHS and determine the severity of OSAHS (mild, moderate or severe)

Lifestyle advice alone for mild OSAHS

• explain to people with mild OSAHS who have no symptoms or with symptoms that do not affect usual daytime activities that:
  • treatment is not usually needed and
  • changes to lifestyle and sleep habits can help to prevent OSAHS from worsening
    • lifestyle advice for all severities of OSAHS (Obstructive sleep apnoea/hypopnoea syndrome)
      • discuss appropriate lifestyle changes with all people with OSAHS. Provide support and information on losing weight, stopping smoking, reducing alcohol intake and improving sleep hygiene, tailored to the person's needs and in line with the NICE guidelines on:
        • stop smoking interventions and services
        • preventing excess weight gain
        • obesity: identification, assessment and management (in particular, the section on lifestyle interventions)
        • alcohol-use disorders: prevention (in particular, recommendations on screening, brief advice and extended brief interventions for adults)
          
          
• continuous positive airway pressure for mild OSAHS
  • for people with mild OSAHS who have symptoms that affect their quality of life and usual daytime activities, offer fixed-level continuous positive airway pressure (CPAP):
    • at the same time as lifestyle advice
    • or if lifestyle advice alone has been unsuccessful or is considered inappropriate
  • for people with mild OSAHS having CPAP:
    • offer telemonitoring with CPAP for up to 12 months
    • consider using telemonitoring beyond 12 months
  • consider auto-CPAP as an alternative to fixed-level CPAP in people with mild OSAHS if:
    • high pressure is needed only for certain times during sleep or
    • they are unable to tolerate fixed-level CPAP or
    • telemonitoring cannot be used for technological reasons or
    • auto-CPAP is available at the same or lower cost than fixed-level CPAP, and this price is guaranteed for an extended period of time
  • consider heated humidification for people with mild OSAHS having CPAP who have upper airway side effects, such as nasal and mouth dryness, and CPAP-induced rhinitis
    
    
• mandibular advancement splints for mild OSAHS
  • if a person with mild OSAHS and symptoms that affect their usual daytime activities is unable to tolerate or declines to try CPAP, consider a customised or semi-customised mandibular advancement splint as an alternative to CPAP if they:
    • are aged 18 and over and
    • have optimal dental and periodontal health
  • be aware that semi-customised mandibular advancement splints may be inappropriate for people with:
    • active periodontal disease or untreated dental decay
    • few or no teeth
    • generalised tonic-clonic seizures.

Reference:

• NICE (August 2021). Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s