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OSA CPAP Alternative — RACP Adult Medicine MCQ

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ModerateRespiratoryOSA CPAP AlternativeRACP Adult Medicine

A 65-year-old man with obstructive sleep apnoea on CPAP therapy is not compliant with his device. His ESR is 15/24 and BMI is 38. He asks about an alternative to CPAP. He has no significant craniofacial abnormality. What is the most effective alternative treatment for moderate-to-severe OSA?

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Correct answer: B — Mandibular advancement splint

For moderate-to-severe OSA with CPAP non-compliance, weight loss is the most effective disease-modifying intervention. A loss of ≥10% body weight can reduce AHI by 50% or more, and may even cure OSA in some patients. Bariatric surgery achieves the greatest weight loss and OSA improvement. However, weight loss takes time – in the interim, mandibular advancement splints are an alternative for mild-moderate OSA. For this patient with BMI 38, weight loss counselling (potentially including bariatric surgery assessment) combined with a mandibular device while CPAP is refused would be optimal.

Reference: TSANZ – 2024 – OSA Position Statement; eTG – 2025 – Respiratory