There is an effort on several fronts for newer effective therapy for obstructive sleep apnea. This is because, till now the two main modalities of therapy, continuous positive airway pressure therapy or use of various oral appliances are fraught with problems of poor acceptance and long time adherence. Though numerous modalities have been tried which are discussed in the review, there are few novel approaches which hold great promise as probable effective modalities for the future. In children, the simplest cost effective treatment undoubtedly remains a well timed adeno-tonsillectomy which could as well be curative. However, a high flow open nasal cannula based positive airway pressure therapy has been found to be effective in mild and moderately obese children. In adults, oral pressure therapy using an external suction apparatus connected to an intra oral device, that increases the retropharyngeal space and prevents the tongue from falling back, has been found to be effective in initial studies. Stimulation of the genioglossus by hypoglossal nerve pacing with the use of a pulse generator placed in the infraclavicular region is another promising modality. Various new surgical techniques specially the maxilla mandibular advancement procedures and computerized surgical planning methods hold great promise. Lastly, the multimodality approach using the new knowledge on the pathophysiology of sleep apnea is likely to be the therapy for the future.
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