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Introduction Continuous Positive Airway Pressure (CPAP) therapy is the first-line treatment for Obstructive Sleep Apnoea (OSA), but long-term adherence to CPAP is limited. This study evaluates the implementation and outcomes of a multidisciplinary team (MDT) approach to manage CPAP-intolerant patients using alternative non-CPAP therapies.Methods A retrospective review was conducted on ‘difficult-to-treat’ OSA cases discussed at multidisciplinary team meetings at the Sleep Disorders Centre at Guy’s and St Thomas’ NHS Foundation Trust [project no. 17160]. Patient demographics, comorbidities, OSA severity (Apnoea-Hypopnoea Index [AHI], Epworth Sleepiness Scale [ESS], 3% Oxygen Desaturation Index [ODI]), management plans and outcomes were extracted from the meeting minutes and clinical records. Statistical analysis was performed using ANOVA to compare baseline characteristics (AHI, age, Body Mass Index [BMI]) across treatment groups, and paired t-tests to assess pre- and post-treatment changes in AHI, ESS, and ODI, with significance set at p<0.05.Results We reviewed a cohort of 138 cases of patients (103/138 male, age 51 (17) years, BMI 29.5 (5.1) kg/m 2) with severe OSA (AHI 37.7 (21.4) hour-1). Common comorbidities included hypertension (29.0%), anxiety/depression (25.4%) and cardiac disease (16.7%). 17.4% had a history of previous ENT intervention. Treatment selection was guided by predefined criteria including OSA severity, BMI, patient preferences, anatomical abnormalities, and comorbid conditions. The recommended management options were tailored Mandibular Advancement Devices (MADs, 27.5%), Hypoglossal Nerve Stimulation (HNS, 24.6%), and weight management (23.9%). Other options included BiPAP/ASV (10.1%), other ENT surgery (10.9%), and CPAP retrial (13.8%) for patients with higher AHI. In comparison, less invasive options such as MAD and specific postural advice (15.9%) were preferred for those with milder OSA (AHI<30). Follow-up data from a subset of patients demonstrated significant reductions in AHI (-44.1%, n=29), ESS (-32.9%, n=13), and ODI (-67.2%, n=12) post-treatment (p<0.05, respectively).Conclusion An interdisciplinary approach enables the delivery of clinical and evidence-based recommendations for OSA patients who have failed conventional treatments, leading to symptomatic improvements in selected individuals through personalised treatment strategies.