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ACP recommends weight loss and CPAP as initial therapy for
Watch Video News Story |
PHILADELPHIA, September 24, 2013 -- People diagnosed with
obstructive sleep apnea (OSA) should lose weight and use continuous
positive airway pressure (CPAP) as initial therapy, according to
new recommendations from the American College of Physicians (ACP)
published today in Annals of Internal Medicine, ACP's flagship
More than 18 million American adults have sleep apnea, which
increases the risk of high blood pressure, heart attack, stroke,
heart failure, and diabetes and increases the chance of driving or
other accidents. Sleep apnea is a leading cause of excessive
The most common type of sleep apnea is OSA, a condition in which
the airway collapses or becomes blocked during sleep causing
shallow breathing or breathing pauses lasting from a few seconds to
minutes. The evidence shows that the incidence of OSA is rising,
likely because of the increasing rates of obesity.
"Obesity is a risk factor for obstructive sleep apnea and the
evidence indicates that intensive weight loss interventions help
improve sleep study results and symptoms of OSA," said Molly Cooke,
MD, FACP, president, ACP. Dr. Cooke is also a member of ACP's
Clinical Guidelines Committee. "Plus, losing extra weight is
associated with many other health benefits."
ACP recommends a mandibular advancement device (MAD) as an
alternative therapy for patients who prefer it or who do not
tolerate or comply with CPAP treatment.
"The evidence shows that a mandibular advancement device can
effectively improve sleep study results and sleepiness," Dr. Cooke
said. "However, CPAP more effectively raised the minimum oxygen
saturation compared to MAD."
ACP's guideline, "Management of Obstructive Sleep Apnea in
Adults," also includes advice to help physicians practice high value care. "Physicians should
stress the importance of compliance with treatments, especially
CPAP," said Dr. Cooke. "Doctors should weigh patient preferences
and the likelihood of therapy adherence against costs before
initiating CPAP treatment."
The available evidence was limited on treating OSA with surgery,
which is associated with serious adverse events and should not be
used as initial treatment.
ACP developed the guideline based on a systematic evidence
review sponsored by the Agency for Healthcare Research and
Although OSA is more common in people who are overweight, the
condition can affect anyone at any age. The risk increases as
people get older. Men are more likely than women to have sleep
apnea. A family history of sleep apnea also increases risk for the
One of the most common signs of OSA is loud and chronic snoring.
Others signs and symptoms of sleep apnea include morning headaches;
memory or learning problems; inability to concentrate; feeling
irritable, depressed, or having mood swings or personality changes;
waking up frequently to urinate; and waking up with dry mouth or a
About the American College of Physicians
The American College of Physicians is the largest
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group in the United States. ACP members include 137,000 internal
medicine physicians (internists), related subspecialists, and
medical students. Internal medicine physicians are specialists who
apply scientific knowledge and clinical expertise to the diagnosis,
treatment, and compassionate care of adults across the spectrum
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