Examples of options we may consider after evaluating you; not everyone qualifies; some uses may be off‑label; risks/contraindications will be reviewed before prescribing.
Many primary care providers, when they suspect obstructive sleep apnea (OSA), refer patients to a sleep specialist for evaluation and at most will maintain existing CPAP prescriptions with annual refills. This leaves patients navigating months-long wait times for sleep studies, struggling with poorly tolerated therapy, or simply going untreated. We take a more comprehensive and proactive approach to both diagnosis and treatment.
Diagnostics
We offer convenient, mail-order home sleep studies that allow you to complete testing in your own bed rather than spending a night in an unfamiliar sleep lab.1,2 Our testing device meets AASM Type 1A criteria with 3% recording accuracy, placing it among the highest sensitivity home sleep tests available—as close as possible to in-lab polysomnography for detecting OSA.3,25,26 These FDA-approved devices provide accurate diagnosis of OSA severity and can be completed within days rather than waiting months for an in-lab study.1,2 For most patients with suspected OSA (without complex comorbidities like central sleep apnea or significant cardiac/pulmonary disease), home sleep testing is reasonably effective and far more accessible.1,2
Medical Management & Weight Loss
For many patients, OSA is directly related to excess weight, particularly around the neck and upper airway. Even modest weight loss (10-15% of body weight) can significantly improve or even resolve OSA in overweight patients.4,5 We actively incorporate medical weight loss strategies into OSA management:
GLP-1 receptor agonists (semaglutide/Wegovy, tirzepatide/Zepbound) – These medications produce substantial, sustained weight loss (15-25% of body weight on average)6-8,27 and have been shown in clinical studies to significantly improve OSA severity.9,28,29 As patients lose weight on GLP-1 therapy, AHI (apnea-hypopnea index) often drops dramatically, sometimes to the point where CPAP is no longer necessary.4,5,9,28 For overweight patients with OSA, GLP-1s address both the metabolic dysfunction and the mechanical airway obstruction simultaneously.4,5,9,28
Combination pharmacotherapy – For patients who need more aggressive weight loss, we can combine GLP-1s with other agents like bupropion, topiramate, metformin, orlistat, or naltrexone to maximize weight reduction and OSA improvement.4,5,10-14 These can also be used without a GLP-1 in case of insurance issues individually providing ~3-10% weight loss each.10-14
Metabolic optimization – Weight loss not only reduces airway obstruction but also decreases systemic inflammation, improves insulin sensitivity, and reduces cardiovascular risk—all of which compound the benefits for OSA patients who frequently have metabolic syndrome.6-9,12-14,30,31
For appropriate patients, medical weight loss can transform OSA from a chronic condition requiring lifelong CPAP into a resolved issue, or at minimum reduce severity enough to make PAP therapy far more tolerable at lower pressures.4,5
Advanced PAP Therapy: BiPAP ASV
(Adaptive Servo-Ventilation)
While CPAP (continuous positive airway pressure) remains the standard first-line therapy, many patients find it poorly tolerated or experience inadequate symptom resolution despite technically “adequate” treatment.15 We offer BiPAP with ASV, a more sophisticated form of positive airway pressure therapy that has been shown to be superior to CPAP in both tolerability and symptom management in complex insomnia patients with co-morbid OSA.16
BiPAP ASV can be particularly valuable for patients with:
• CPAP intolerance or failure
• Residual daytime sleepiness despite “compliant” CPAP use
• Central or complex sleep apnea patterns
• Residual insomnia symptoms (complex insomnia) alongside OSA16
• Difficulty tolerating high CPAP pressures
trial in chronic complex insomnia patients with OSA; individual results vary; clinician evaluation required.16 ASV is contraindicated in patients with symptomatic, chronic heart failure (NYHA 2-4) with reduced left ventricular ejection fraction (LVEF ≤ 45%) and moderate to severe predominant central sleep apnea.17,18
Surgical Options – Curative Approach
For patients seeking long-term solutions rather than nightly device dependence, we provide detailed discussions of modern surgical treatments that can actually be curative, unlike older procedures (uvulopalatopharyngoplasty/UPPP, tongue reduction) that had poor success rates and significant morbidity.19-21
Maxillomandibular Advancement (MMA) – The gold standard surgical treatment for OSA, with success rates exceeding 85-90% in appropriately selected patients.22,23,32,34 This procedure advances both the upper jaw (maxilla) and lower jaw (mandible) forward, expanding the entire airway from the nose through the throat. Beyond curing sleep apnea, MMA often significantly improves facial aesthetics by enhancing jaw projection, improving facial balance, and creating a more youthful appearance.33,34 Unlike UPPP, which destroys tissue, MMA creates space—addressing the root anatomical problem.22,23
Nasomaxillary Expansion (MSE/MARPE/FME/EASE) – As discussed in our allergies and nasal obstruction post, this procedure expands the upper jaw, widening the nasal passages and improving nasal breathing.24 For patients with OSA who also have nasal obstruction or midface deficiency, this can be combined with MMA or used as a standalone treatment. Like MMA, it may improve facial aesthetics while addressing the underlying skeletal restriction causing airway collapse. It is often used in combination with MMA as part of a two phase treatment.24
We’re happy to discuss specific surgeons and orthodontists with expertise in these procedures and help you determine if you’re a surgical candidate. For many patients—particularly younger individuals tired of nightly devices, those with anatomical skeletal deficiency, or people who’ve failed conservative therapy—these surgical options represent a genuine cure rather than lifelong management.
Our approach is comprehensive: accurate and convenient diagnosis using the highest-sensitivity home testing available, medical management through weight loss when appropriate, optimization of PAP therapy (including advanced technologies that go beyond basic CPAP), and informed discussion of surgical options that can permanently resolve OSA while potentially improving facial structure and aesthetics.1,2,3,4-6,15,22-29,33,34
References
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2. Rosen IM, Kirsch DB, Carden KA, et al. Clinical use of a home sleep apnea test: an updated American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2018;14(12):2075-2077. doi:10.5664/jcsm.7540
3. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med. 2012;8(5):597-619. doi:10.5664/jcsm.2172
4. Foster GD, Borradaile KE, Sanders MH, et al. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med. 2009;169(17):1619-1626. doi:10.1001/archinternmed.2009.266
5. Georgoulis M, Yiannakouris N, Kechribari I, et al. Dose-response relationship between weight loss and improvements in obstructive sleep apnea severity after a diet/lifestyle interventions: secondary analyses of the “MIMOSA” randomized clinical trial. J Clin Sleep Med. 2022;18(5):1251-1261. doi:10.5664/jcsm.9834
6. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183
7. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038
8. Wadden TA, Chao AM, Machineni S, et al. Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial. Nat Med. 2023;29(11):2909-2918. doi:10.1038/s41591-023-02597-w
9. Blackman A, Foster GD, Zammit G, et al. Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE Sleep Apnea randomized clinical trial. Int J Obes (Lond). 2016;40(8):1310-1319. doi:10.1038/ijo.2016.52
10. Anderson JW, Greenway FL, Fujioka K, Gadde KM, McKenney J, O’Neil PM. Bupropion SR enhances weight loss: a 48-week double-blind, placebo-controlled trial. Obes Res. 2002;10(7):633-641. doi:10.1038/oby.2002.86
11. Bray GA, Hollander P, Klein S, et al. A 6-month randomized, placebo-controlled, dose-ranging trial of topiramate for weight loss in obesity. Obes Res. 2003;11(6):722-733. doi:10.1038/oby.2003.102
12. Haber R, et al. The impact of metformin on weight and metabolic parameters in patients with obesity: a systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2024;26(5):1850-1867. doi:10.1111/dom.15501
13. Sjöström L, Rissanen A, Andersen T, et al; European Multicentre Orlistat Study Group. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. Lancet. 1998;352(9123):167-172. doi:10.1016/S0140-6736(97)11509-4
14. Wadden TA, Foreyt JP, Foster GD, et al. Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: the COR-BMOD trial. Obesity (Silver Spring). 2011;19(1):110-120. doi:10.1038/oby.2010.147
15. Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019;15(2):335-343. doi:10.5664/jcsm.7640
16. Krakow B, McIver ND, Ulibarri VA, et al. Prospective randomized controlled trial on the efficacy of continuous positive airway pressure and adaptive servo-ventilation in the treatment of chronic complex insomnia. EClinicalMedicine. 2019;13:57-73. doi:10.1016/j.eclinm.2019.06.011
17. Cowie MR, Woehrle H, Wegscheider K, et al. Adaptive servo-ventilation for central sleep apnea in systolic heart failure. N Engl J Med. 2015;373(12):1095-1105. doi:10.1056/NEJMoa1506459
18. Aurora RN, Bista SR, Casey KR, et al. Updated adaptive servo-ventilation recommendations for the 2012 AASM guideline: “The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses.” J Clin Sleep Med. 2016;12(5):757-761. doi:10.5664/jcsm.5812
19. Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. 1996;19(2):156-177. doi:10.1093/sleep/19.2.156
20. Choi JH, et al. Predicting outcomes after uvulopalatopharyngoplasty for adult obstructive sleep apnea: a meta-analysis. Otolaryngol Head Neck Surg. 2016;155(6):904-913. doi:10.1177/0194599816661481
21. He M, Yin G, Zhan S, et al. Long-term efficacy of uvulopalatopharyngoplasty among adult patients with obstructive sleep apnea: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2019;161(3):401-411. doi:10.1177/0194599819840356
22. Holty JEC, Guilleminault C. Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev. 2010;14(5):287-297. doi:10.1016/j.smrv.2009.11.003
23. Zaghi S, Holty JEC, Certal V, et al. Maxillomandibular advancement for treatment of obstructive sleep apnea: a meta-analysis. JAMA Otolaryngol Head Neck Surg. 2016;142(1):58-66. doi:10.1001/jamaoto.2015.2678
24. Li K, Quo S, Guilleminault C. Endoscopically-assisted surgical expansion (EASE) for the treatment of obstructive sleep apnea. Sleep Med. 2019;60:53-59. doi:10.1016/j.sleep.2018.09.008
25. El Shayeb M, Topfer LA, Stafinski T, et al. Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ. 2014;186(1):E25-E51. doi:10.1503/cmaj.130952
26. Portier F, Portmann A, Czernichow P, et al. Evaluation of home versus laboratory polysomnography in the diagnosis of sleep apnea syndrome. Am J Respir Crit Care Med. 2000;162(3 Pt 1):814-818. doi:10.1164/ajrccm.162.3.9908002
27. Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial. JAMA. 2024;331(1):38-48. doi:10.1001/jama.2023.24945
28. Malhotra A, et al. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. N Engl J Med. 2024;391(13):1193-1205. doi:10.1056/NEJMoa2404881
29. U.S. Food and Drug Administration. FDA Approves First Medication for Obstructive Sleep Apnea. FDA News Release. December 20, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea
30. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563
31. U.S. Food and Drug Administration. FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults with Obesity or Overweight. FDA News Release. March 08, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or
32. Camacho M, Liu SY, Certal V, et al. Large maxillomandibular advancements for obstructive sleep apnea: an operative technique evolved over 30 years. J Craniomaxillofac Surg. 2015;43:1113-1118. doi:10.1016/j.jcms.2015.05.015
33. Curran J, Shimizu M, Tassi A. Evaluation of Facial Profile Esthetics After Maxillomandibular Advancement Surgery for the Treatment of Obstructive Sleep Apnea. J Oral Maxillofac Surg. 2022;80(1):174-184. doi:10.1016/j.joms.2021.08.163
34. Jamal BT, Ibrahim EA. Satisfaction With Facial Aesthetic Appearance Following Maxillomandibular Advancement (MMA) for Obstructive Sleep Apnea (OSA): A Meta-Analysis. Cureus. 2023;15(2):e35568. doi:10.7759/cureus.35568
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