Current Perspectives in Treatment of Obstructive Sleep Apnea: Positive Airway Pressure

Purpose of ReviewSleep apnea is prevalent and associated with increased overall and cardiovascular morbidity and mortality. Positive airway pressure has been the mainstay of treatment for decades, however newer treatments are available. We provide an update on the state of positive airway pressure delivery and its effectiveness compared to other sleep apnea treatments.Recent FindingsWell-designed prospective cohort studies of sleep apnea have consistently demonstrated morbidity and mortality benefit with positive airway pressure. Randomized controlled trials have not consistently demonstrated such clear benefit, albeit with major limitations related to methodology and exclusion criteria. Positive airway pressure consistently outperforms weight loss, oral appliances, and hypoglossal nerve stimulation in sleep apnea treatment, however pre-treatment bias and discomfort remain barriers to compliance.Although advances in medical, surgical and device- related management of sleep apnea show promise, positive airway pressure remains the most effective treatment. Advances in device and mask technology may improve compliance over time.