Therapeutic options for patients with obstructive sleep apnoea: a retrospective review of difficult-to-treat cases in a multidisciplinary approach.

INTRODUCTION: Continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnoea (OSA) but long-term adherence is limited. This study evaluates the implementation and outcomes of a multidisciplinary team approach to managing CPAP-intolerant patients using alternative therapies. METHODS: A retrospective review was conducted on 'difficult-to-treat' OSA cases discussed at multidisciplinary team meetings at the Guy's and St Thomas' NHS Foundation Trust Sleep Disorders Centre (project number 17 160). 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 meeting minutes and clinical records. Statistical analysis included analysis of variance (ANOVA) to compare baseline characteristics (AHI, age, body mass index (BMI)) across treatment groups and paired t-tests to assess pre-treatment and post-treatment changes in OSA indices (p<0.05). RESULTS: We reviewed a cohort of 138 patients (103/138 male, age 51 (17) years, BMI 29.5 (5.1) kg/m2) with severe OSA (AHI 37.7 (21.4)/hour). Common comorbidities included hypertension (29.0%), anxiety/depression (25.4%), history of previous Otorhinolaryngology (ENT) intervention (17.4%) and cardiac diseases (16.7%). Treatment selection was guided by predefined criteria, including OSA severity, BMI, patient preferences, anatomical abnormalities and comorbidities. Treatment recommendations included mandibular advancement devices (27.5%), hypoglossal nerve stimulation pathway (24.6%), weight management (23.9%), CPAP retrial (13.8%), other ENT surgery (10.9%) and BiPAP/ASV (10.1%). Follow-up data from patients with postintervention 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). CONCLUSION: A multidisciplinary approach enables structured delivery of evidence-based treatment selection for patients with OSA who failed first-line therapy. Observed improvements in a subset of patients suggest potential benefit of tailored non-CPAP strategies and super-regional accessibility.