Original Title: Analyserapport vedrørende Behandling af patienter med obstruktiv søvnapnø

Authors' objectives: The objective of this Health Technology Assessment (HTA) was to evaluate the effectiveness, safety, patient experiences, organizational factors, and cost-effectiveness of available treatment modalities for adult patients with obstructive sleep apnea (OSA), including CPAP, mandibular advancement devices (MAD), positional therapy, and surgery. The analysis aimed to inform optimal treatment decisions for different OSA severity levels and anatomical indications.

Authors' results and conclusions: Evidence from 99 RCTs demonstrates that CPAP, MAD, and surgery are effective in reducing apnea severity and daytime sleepiness in patients with moderate to severe OSA, with CPAP showing the most consistent effects across patient groups. In patients with mild OSA, evidence is limited and does not support treatment except in cases with severe daytime symptoms. Surgical efficacy is dependent on anatomical suitability, and risks of complications must be considered. A thematic synthesis of 25 qualitative studies highlights both facilitators and barriers related to physical, psychological, relational, and organizational factors across treatments. CPAP users value improved energy but face issues such as mask discomfort and stigma. Discreet treatment options (e.g., MAD) are often preferred, and professional support influences adherence. Patients express a desire for alternative treatments to CPAP and emphasize the importance of shared decision-making. There is significant regional variation in the organization and availability of OSA treatments in Denmark. Experts call for standardized, interdisciplinary pathways to ensure equitable access and systematic follow-up, including the potential use of telemonitoring. Cost-utility analyses suggest that CPAP has the highest probability of being cost-effective across most subgroups, depending on willingness-to-pay thresholds. However, under certain assumptions, MAD and positional therapy may be more cost-effective, especially in selected patients with moderate OSA or positional OSA (POSA). Conclusion Treatment for OSA should be individualized based on OSA severity, symptom burden, patient anatomy, and preferences. While CPAP remains the most broadly effective treatment, alternative modalities such as MAD, positional therapy, or surgery may be appropriate for selected patients. Equity in access, interdisciplinary coordination, and patient involvement are key to achieving optimal outcomes.

Project Status: Completed

Year Published: 2024

URL for published report: https://www.sundk.dk/media/pgzikixc/behandlingsraadet-analyserapport.pdf

English language abstract: There is no English language summary available

Publication Type: Not Assigned

Country: Denmark

Organisation Name: The Danish Health Technology Council

Contact Address: Niels Jernes Vej 6a, 9220 Aalborg

Contact Name: Nikolaj Hellmuth Skak

Contact Email: nsp@behandlingsraadet.dk