Treatment of obstructive sleep apnea syndrome. A personal view based upon evaluation of over 4000 patients.

Obstructive sleep apnea syndrome (OSAS) is a common problem in middle-aged men. It is a syndrome often associated with upper airway anatomical abnormalities, but where the sleep disorder, part of the syndrome, impairs local upper airway reflexes involved in appropriate air exchange during sleep. We now have many possible treatments. It is better to associate them in a step-by-step approach. This implies development of appropriate services able to follow OSAS patients regularly. The immediate goal is to assure normal ventilation during sleep and maintenance of normal blood gases. This is obtained by use of nasal CPAP or nasal IPPV, less mutilating than tracheostomy. Weight loss and behavioral modification programs will improve some of the associated features of obesity, alcoholic intake, and smoking often associated with and worsening the sleep-related breathing disorders. Finally, an appropriate evaluation of the upper airway abnormalities will allow surgical approaches that, as a second step, will lead to an appropriate reconstruction of the upper airway and will allow discontinuation of mechanical devices, with a subsequent return to normal life for the patient. To offer only one of these services or to limit oneself to a single therapeutic approach is a long-term disservice to OSAS patients.