Hostname: page-component-6766d58669-vgfm9 Total loading time: 0 Render date: 2026-05-16T06:06:36.743Z Has data issue: false hasContentIssue false
  • English
  • Français

Variations in funding for treatment of obstructive sleep apnoea in England

Published online by Cambridge University Press:  29 April 2021

K Chaidas  and
A Ashman
K Chaidas*
Affiliation:
ENT Department, John Radcliffe Hospital, Oxford, UK
A Ashman
Affiliation:
ENT Department, John Radcliffe Hospital, Oxford, UK
*
Author for correspondence: Mr Konstantinos Chaidas, ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK E-mail: konchaidas@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

This study aimed to review the funding policies of clinical commissioning groups for treatment of obstructive sleep apnoea in England.

Methods

Published policies from a randomly selected sample of 60 out of 190 clinical commissioning groups were reviewed.

Results

Continuous positive airway pressure was funded based on a clinical assessment or according to criteria that were in line with national guidelines in most clinical commissioning groups (49 of 60), with 11 clinical commissioning groups offering no policy. Mandibular advancement devices, tonsillectomy and nasal surgery were funded based on a clinical assessment or certain criteria in 16, 25 and 16 clinical commissioning groups, respectively. In contrast, only one clinical commissioning group provided funding for soft palate, tongue base or mandibular surgery. Hypoglossal nerve stimulation was not mentioned in any clinical commissioning group's policy.

Conclusion

Although most clinical commissioning groups provide funding for the use of continuous positive airway pressure, the availability of funding for other obstructive sleep apnoea treatment modalities is heterogeneous, leaving continuous positive airway pressure intolerant patients with limited therapeutic options in some regions.

Keywords

Obstructive Sleep ApneaContinuous Positive Airway PressureMandibular Advancement Device

Information

Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 5 , May 2021 , pp. 385 - 390
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Mr K Chaidas takes responsibility for the integrity of the content of the paper

References

Senaratna, CV, Perret, JL, Lodge, CJ, Lowe, AJ, Campbell, BE, Matheson, MC et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 2017;34:70–81CrossRefGoogle ScholarPubMed
Marin, JM, Carrizo, SJ, Vicente, E, Agusti, AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046–53CrossRefGoogle ScholarPubMed
Yaggi, HK, Concato, J, Kernan, WN, Lichtman, JH, Brass, LM, Mohsenin, V. Obstructive sleep apnea as a risk factor for stroke and death. N Eng J Med 2005;353:2034–41CrossRefGoogle ScholarPubMed
Sleep Alliance. Sleep SOS report: the impact of sleep on society. 2004. In: https://www.rospa.com/rospaweb/docs/advice-services/road-safety/drivers/sleep.pdf [22 April 2020]Google Scholar
Marshall, NS, Wong, KKH, Liu, PY, Cullen, SR, Knuiman, MW, Grunstein, RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep 2008;31:1079–85Google ScholarPubMed
Walter, RJ, Hagedorn, SI, Lettieri, CJ. Impact of diagnosing and treating obstructive sleep apnea on healthcare utilization. Sleep Med 2017;38:73–7CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence (NICE). Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. 2008. In: https://www.nice.org.uk/guidance/ta139 [14 April 2020]Google Scholar
Rejon-Parrilla, JC, Garau, M, Sussex, J. Obstructive sleep apnoea health economics report. Consulting report for the British Lung Foundation. 2014. In: https://www.blf.org.uk/sites/default/files/OHE-OSA-health-economics-report---FINAL---v2.pdf [14 April 2020]Google Scholar
Mandavia, R, Mehta, N, Veer, V. Guidelines on the surgical management of sleep disorders: a systematic review. Laryngoscope 2020;130:1070–84CrossRefGoogle ScholarPubMed
Epstein, LJ, Kristo, D, Strollo, PJ Jr, Friedman, N, Malhotra, A, Patil, SP et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5:263–76Google ScholarPubMed
Weaver, TE, Grunstein, RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 2008;5:173–8CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence (NICE). Soft-palate implants for obstructive sleep apnoea. 2007. In: https://www.nice.org.uk/guidance/ipg241 [22 April 2020]Google Scholar
National Institute for Health and Clinical Excellence (NICE). Radiofrequency ablation of the soft palate for snoring. 2014. In: https://www.nice.org.uk/guidance/ipg476 [22 April 2020]Google Scholar
National Institute for Health and Clinical Excellence (NICE). Hypoglossal nerve stimulation for moderate to severe obstructive sleep apnoea. 2017. In: https://www.nice.org.uk/guidance/ipg598 [22 April 2020]Google Scholar
Wimms, AJ, Kelly, JL, Turnbull, CD, McMillan, A, Craig, SE, O'Reilly, JF et al. Continuous positive airway pressure versus standard care for the treatment of people with mild obstructive sleep apnoea (MERGE): a multicentre, randomised controlled trial. Lancet Respir Med 2020;8:349–58CrossRefGoogle ScholarPubMed
Aurora, RN, Casey, KR, Kristo, D, Auerbach, S, Bista, SR, Chowdhuri, S et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep 2010;33:1408–13CrossRefGoogle ScholarPubMed
Verse, T, Dreher, A, Heiser, C, Herzog, M, Maurer, JT, Pirsig, W et al. ENT-specific therapy of obstructive sleep apnoea in adults: a revised version of the previously published German S2e guideline. Sleep Breath 2016;20:1301–11CrossRefGoogle ScholarPubMed
Lloberes, P, Duran-Cantolla, J, Martinez-Garcia, MA, Marin, JM, Ferrer, A, Corral, J et al. Diagnosis and treatment of sleep apnea-hypopnea syndrome. Spanish Society of Pulmonology and Thoracic Surgery. Arch Bronconeumol 2011;47:143–56CrossRefGoogle ScholarPubMed
Ishii, LE, Tollefson, TT, Basura, GJ, Rosenfeld, RM, Abramson, PJ, Chaiet, SR et al. Clinical practice guideline: Improving nasal form and function after rhinoplasty. Otolaryngol Head Neck Surg 2017;156:S1–S30CrossRefGoogle ScholarPubMed
Sadatsafavi, M, Marra, CA, Ayas, NT, Stradling, J, Fleetham, J. Cost-effectiveness of oral appliances in the treatment of obstructive sleep apnoea-hypopnoea. Sleep Breath 2009;13:241–52CrossRefGoogle ScholarPubMed
Quinnell, TG, Bennett, M, Jordan, J, Clutterbuck-James, AL, Davies, MG, Smith, IE et al. A crossover randomised controlled trial of oral mandibular advancement devices for obstructive sleep apnoea-hypopnoea (TOMADO). Thorax 2014;69:938–45CrossRefGoogle Scholar
Tan, KB, Toh, ST, Guilleminault, C, Holty, JE. A cost effectiveness analysis of surgery for middle-aged men with severe obstructive sleep apnea intolerant of CPAP. J Clin Sleep Med 2015;11:525–35CrossRefGoogle ScholarPubMed
Pietzsch, JB, Liu, S, Garner, AM, Kezirian, EJ, Strollo, PJ. Long-term cost-effectiveness of upper airway stimulation for the treatment of obstructive sleep apnea: a model-based projection based on the STAR trial. Sleep 2015;38:735–44CrossRefGoogle ScholarPubMed
Tsai, WH, Vazquez, JC, Oshima, T, Dort, L, Roycroft, B, Lowe, AA et al. Remotely controlled mandibular positioner predicts efficacy of oral appliances in sleep apnea. Am J Respir Crit Care Med 2004;170:366–70CrossRefGoogle ScholarPubMed
Schwab, RJ, Pasirstein, M, Pierson, R, Mackley, A, Hachadoorian, R, Arens, R et al. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 2003;168:522–30CrossRefGoogle ScholarPubMed
Marklund, M, Braem, MJA, Verbraecken, J. Update on oral appliance therapy. Eur Respir Rev 2019;28:190083CrossRefGoogle ScholarPubMed
Vanderveken, OM, Hoekema, A. How to treat patients that do not tolerate continuous positive airway pressure. Breathe 2010;7:157–67CrossRefGoogle Scholar
Blanco, J, Zamarron, C, Abeleira Pazos, MT, Lamela, C, Suarez Quintanilla, D. Prospective evaluation of an oral appliance in the treatment of obstructive sleep apnea syndrome. Sleep Breath 2005;9:20–5CrossRefGoogle ScholarPubMed
Petri, N, Svanholt, P, Solow, B, Wildschiødtz, G, Winkel, P. Mandibular advancement appliance for obstructive sleep apnoea: results of a randomised placebo controlled trial using parallel group design. J Sleep Res 2008;17:221–29CrossRefGoogle ScholarPubMed
Vanderveken, OM, Devolder, A, Marklund, M, Boudewyns, AN, Braem, MJ, Okkerse, W et al. Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med 2008;178:197–202CrossRefGoogle Scholar
Aarab, G, Lobbezoo, F, Heymans, MW, Hamburger, HL, Naeije, M. Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respiration 2011;82:162–8CrossRefGoogle ScholarPubMed
Sharma, SK, Katoch, VM, Mohan, A, Kadhiravan, T, Elavarasi, A, Ragesh, R et al. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 (first edition). Lung India 2015;32:422–34CrossRefGoogle Scholar
Fleetham, J, Ayas, N, Bradley, D, Fitzpatrick, M, Oliver, TK, Morrison, D et al. Canadian Thoracic Society 2011 guideline update: diagnosis and treatment of sleep disordered breathing. Can Respir J 2011;18:25–47CrossRefGoogle ScholarPubMed
Fischer, J, Dogas, Z, Bassetti, CL, Berg, S, Grote, L, Jennum, P et al. Standard procedures for adults in accredited sleep medicine centres in Europe. J Sleep Res 2012;21:357–68CrossRefGoogle ScholarPubMed
Ramar, K, Dort, LC, Katz, SG, Lettieri, CJ, Harrod, CG, Thomas, SM et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 2015;11:773–827CrossRefGoogle ScholarPubMed
Camacho, M, Li, D, Kawai, M, Zaghi, S, Teixeira, J, Senchak, AJ et al. Tonsillectomy for adult obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 2016;126:2176–86CrossRefGoogle ScholarPubMed
Brietzke, SE, Mair, EA. Injection snoreplasty: how to treat snoring without all the pain and expense. Otolaryngol Head Neck Surg 2001;124:503–10CrossRefGoogle ScholarPubMed
Farrar, J, Ryan, J, Oliver, E, Gillespie, MB. Radiofrequency ablation for the treatment of obstructive sleep apnea: a meta-analysis. Laryngoscope 2008;118:1878–83CrossRefGoogle ScholarPubMed
Stuck, BA, Ravesloot, MJL, Eschenhagen, T, de Vet, HCW, Sommer, JU. Uvulopalatopharyngoplasty with or without tonsillectomy in the treatment of adult obstructive sleep apnea - a systematic review. Sleep Med 2018;50:152–65CrossRefGoogle ScholarPubMed
Browaldh, N, Nerfeldt, P, Lysdahl, M, Bring, J, Friberg, D. SKUP3 randomised controlled trial: polysomnographic results after uvulopalatopharyngoplasty in selected patients with obstructive sleep apnoea. Thorax 2013;68:846–53CrossRefGoogle ScholarPubMed
Browaldh, N, Bring, J, Friberg, D. SKUP3: 6 and 24 months follow-up of changes in respiration and sleepiness after modified UPPP. Laryngoscope 2018;128:1238–44CrossRefGoogle ScholarPubMed
Chisholm, E, Kotecha, B. Oropharyngeal surgery for obstructive sleep apnoea in CPAP failures. Eur Arch Otorhinolaryngol 2007;264:51–5CrossRefGoogle ScholarPubMed
Pang, KP, Pang, EB, Win, MT, Pang, KA, Woodson, BT. Expansion sphincter pharyngoplasty for the treatment of OSA: a systemic review and meta-analysis. Eur Arch Otorhinolaryngol 2016;273:2329–33CrossRefGoogle ScholarPubMed
Murphey, AW, Kandl, JA, Nguyen, SA, Weber, AC, Gillespie, MB. The effect of glossectomy for obstructive sleep apnea: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2015;153: 334–42CrossRefGoogle ScholarPubMed
Arora, A, Chaidas, K, Garas, G, Amlani, A, Darzi, A, Kotecha, B et al. Outcome of TORS to tongue base and epiglottis in patients with OSA intolerant of conventional treatment. Sleep Breath 2016;20:739–47CrossRefGoogle ScholarPubMed
Miller, SC, Nguyen, SA, Ong, AA, Gillespie, MB. Transoral robotic base of tongue reduction for obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 2017;127:258–65CrossRefGoogle ScholarPubMed
Sugiura, T, Noda, A, Nakata, S, Yasuda, Y, Soga, T, Miyata, S et al. Influence of nasal resistance on initial acceptance of continuous positive airway pressure in treatment for obstructive sleep apnea syndrome. Respiration 2007;74:56–60CrossRefGoogle ScholarPubMed
Brander, PE, Soirinsuo, M, Lohela, P. Nasopharyngeal symptoms in patients with obstructive sleep apnea syndrome. Effect of nasal CPAP treatment. Respiration 1999;66:128–35CrossRefGoogle ScholarPubMed
Bachour, A, Maasilta, P. Mouth breathing compromises adherence to nasal continuous positive airway pressure therapy. Chest 2004;126:1248–54CrossRefGoogle ScholarPubMed
Inoue, A, Chiba, S, Matsuura, K, Osafune, H, Capasso, R, Wada, K. Nasal function and CPAP compliance. Auris Nasus Larynx 2019;46:548–58CrossRefGoogle ScholarPubMed
Camacho, M, Riaz, M, Capasso, R, Ruoff, CM, Guilleminault, C, Kushida, CA et al. The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment pressures: a systematic review and meta-analysis. Sleep 2015;38:279–86CrossRefGoogle ScholarPubMed
Yu, JL, Thaler, ER. Hypoglossal nerve (cranial nerve XII) stimulation. Otolaryngol Clin North Am 2020;53:157–69CrossRefGoogle ScholarPubMed
Strollo, PJ Jr, Soose, RJ, Maurer, JT, de Vries, N, Cornelius, J, Froymovich, O et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med 2014;370:139–49CrossRefGoogle ScholarPubMed
Faria, AC, Xavier, SP, Silva, SN Jr, Trawitzki, LV, de Mello-Filho, FV. Cephalometric analysis of modifications of the pharynx due to maxillo-mandibular advancement surgery in patients with obstructive sleep apnea. Int J Oral Maxillofac Surg 2013;42:579–84CrossRefGoogle ScholarPubMed
Hsieh, YJ, Liao, YF. Effects of maxillomandibular advancement on the upper airway and surrounding structures in patients with obstructive sleep apnoea: a systematic review. Br J Oral Maxillofac Surg 2013;51:834–40CrossRefGoogle ScholarPubMed
Holty, JE, Guilleminault, C. Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev 2010;14:287–97CrossRefGoogle ScholarPubMed