Document resource
Introduction Continuous Positive Airway Pressure (CPAP) remains the first-line therapy for Obstructive Sleep Apnoea (OSA). However, limited long-term adherence highlights the importance of developing effective non-CPAP therapeutic options. This study evaluates how demographic, physiological, and anatomical factors influence the selection of non-CPAP therapies in a multidisciplinary team (MDT) approach.Methods A retrospective review was conducted including ‘difficult-to-treat’ OSA cases discussed in MDT meetings at Guy’s and St Thomas’ NHS Foundation Trust Sleep Disorders Centre from 2020-2025 [project no.17160]. Demographics, OSA severity (Apnoea-Hypopnoea Index[AHI], Epworth Sleepiness Scale[ESS], 3% Oxygen Desaturation Index[ODI]), Drug-Induced Sleep Endoscopy(DISE) findings, management plans and outcomes were recorded. One-way ANOVA was performed to identify differences (p<0.05) in baseline characteristics (age, gender, Body Mass Index [BMI], AHI) across treatment groups.Results We reviewed a cohort of 138 patients (103/138 male, age 51(17)years, BMI 29.5(5.1)kg/m2) with OSA (AHI 37.7(21.4)hour-1, ESS 12.4(6.1)points, ODI 36.1(22.6)hour-1). Recommended non-CPAP therapies were tailored Mandibular Advancement Devices (MADs, 27.5%), Hypoglossal Nerve Stimulation (HNS, 24.6%), and weight management (23.9%). Treatment selection was influenced by baseline AHI (p<0.001) and BMI (p<0.001), but not age (p=0.92) or gender (p=0.43). Other therapies, such as BiPAP/ASV, oromaxillary surgery, and HNS, were associated with higher AHI values (>30hour-1). Conventional approaches, such as MAD and postural advice, were more common in patients with an AHI<30hour-1. DISE played a critical role in selecting patients for HNS or surgery; among the 28 patients who underwent DISE, patients with anterior-posterior collapse were suitable for HNS, while those with complete concentric collapse (CCC) or other unfavourable anatomical features were more likely considered for other surgical interventions. Follow-up data 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 Patients with OSA who are CPAP intolerant can be supported by evidence-based personalised, phenotype-informed therapeutic recommendations facilitated by an MDT approach.