Therapeutic Management of Obstructive Sleep Apnea: Clinical and Surgical Interventions

• DOI: https://doi.org/10.22533/at.ed.15953325281012

• Palavras-chave: Obstructive Sleep Apnea; Treatment; CPAP; Mandibular Advancement Device; Bariatric Surgery; Positional Therapy.

• Keywords: Obstructive Sleep Apnea; Treatment; CPAP; Mandibular Advancement Device; Bariatric Surgery; Positional Therapy.

• Abstract:

  Obstructive sleep apnea (OSA) is a prevalent respiratory disorder characterized by recurrent obstruction of the upper airways, associated with significant cardiovascular and neurocognitive morbidity. Although continuous positive airway pressure (CPAP) treatment is the gold standard, low patient adherence represents a central clinical challenge. This narrative review, based on articles from the last five years in the PubMed database, aimed to analyze recent evidence on clinical and surgical interventions. The results indicate that mandibular advancement devices (MADs) are an effective alternative with high adherence for mild to moderate OSA, especially in patients with specific phenotypes (young people, women, low BMI). Bariatric surgery and emerging GLP-1 agonists (liraglutide, semaglutide) demonstrate efficacy in reducing the apnea-hypopnea index (AHI) through weight loss, although a cure is not guaranteed. Positional therapy is useful for selected cases, while pharmacological therapies remain without robust validation. It is concluded that the treatment of OSA requires a multimodal and individualized approach, based on the patient's phenotype, aiming to balance the effectiveness in reducing AHI with long-term therapeutic adherence.