Future developments and research needs
There needs to be a continued effort to better define specific populations with OSAS and to learn which of these populations will respond most favourably to the various forms of treatment available.
Future developments should include devoting more resources to targeted prevention and raising awareness of OSAS. Individuals who are sleepy, who snore and, particularly, those who experience sleepiness while driving, should be encouraged to seek medical advice. Secondary prevention needs to be expanded by improved screening of those presenting with suggestive symptoms and those with associated cardio-metabolic comorbidities. And finally, tertiary prevention, i.e. the treatment of patients with OSAS, involves expanding facilities to provide timely investigation and treatment of the large number of patients currently undiagnosed or untreated. As the prevalence of OSAS within the community is considerable, and, in many countries, is being further exacerbated by the current obesity epidemic, the resources needed are large and require commitment by national governments. National health and transport authorities need to recognise the common and potentially severe effects on driving (both privately and commercially) of sleepiness due to OSAS – a phenomenon that puts both the individual and the general public at risk. The problem needs to be formally recognised by appropriate legislation, which is sorely lacking in many European countries. In most European countries, waiting lists for assessment and treatment of OSAS are a serious problem for both patients and medical staff – facilities need to be expanded. High-priority research needs in OSAS include the following:
- Epidemiological studies of the prevalence of OSAS and OHS across Europe
- Assessment of the impact of OSAS and its severity on mortality, cardiovascular disease and type II diabetes mellitus.
- Analyses of the cost-effectiveness of various management strategies for OSAS patients according to disease severity, including long-term outcomes.
- Comparative cost–benefit analyses of different OSAS treatments (CPAP versus MRD versus surgery) stratified according to patient characteristics, disease characteristics and comorbidities, and including long-term outcomes, e.g. severe OSAS in patients with Down syndrome and elderly patients with mild disease.
- Investigation of: treatment adherence strategies for the various treatment modalities available; financial considerations in implementing treatment; and the role of specialised sleep services in the assessment and management of OSAS, e.g. should OSAS remain a secondary/tertiary care problem or be devolved into primary care with referral of only difficult cases?
A number of studies are in progress addressing OSAS in the ageing population and in children. It is important to recognise that some populations, such as the elderly, the very young, the intellectually disabled and those with particular morbidities, may have different treatment needs and responses to treatment.
Although not successful to date, the search for a pharmacological treatment for OSAS that can be used together with current treatment modalities for OSAS should be encouraged.
Further effort is needed to simplify diagnostic approaches while maintaining accuracy, including increasing the use of polygraphy and using new technologies, such as telemedicine, to diagnose and monitor patients. Since publication of the first edition of this book in 2003, these needs have not been adequately addressed and have not been met by the requisite public health and research funding. Funding should also be directed towards greater public awareness of the common risk factors for OSAS such as obesity and relevant craniofacial variants. Orthodontic treatments instituted in early life might come to play a more important role in prevention. Longitudinal cohort studies of OSAS are few and should be instituted as the significance of this disorder in children and young adults is increasingly recognised.