The most appropriate treatment alternative to continuous positive airway pressure (CPAP) in this patient is an oral mandibular advancement appliance. This patient has symptomatic obstructive sleep apnea (OSA) of moderate severity. Although CPAP provided symptomatic improvement and is generally the preferred treatment for OSA, patient preference or intolerance of CPAP should prompt consideration of other treatments. Oral appliances are an alternative to CPAP therapy for mild to moderate OSA. Randomized controlled trials on the use of oral appliances have demonstrated reasonable control of OSA and improvement in symptoms such as daytime sleepiness. In addition, their use as an alternative therapy is consistent with the American College of Physicians Clinical Practice Guideline for Management of Obstructive Sleep Apnea in Adults. These devices act by one of two mechanisms to increase upper airway caliber: (1) advancement of the mandible by traction or (2) preventing posterior displacement of the tongue by suction.

Treatment of OSA should be directed at maintaining upper airway patency. Supplemental oxygen has no effect on the upper airway and is not indicated as primary therapy for OSA.

Evidence supporting surgical procedures as a treatment for OSA is limited. Patient selection is not standardized, and outcomes related to the long-term adverse consequences of OSA are either unknown or inconsistent. Case series have demonstrated significant improvements in the apnea-hypopnea index (AHI) following maxillomandibular advancement; however, in most patients it would not be considered a primary treatment owing to its level of invasiveness. Literature examining uvulopalatopharyngoplasty, a soft-palate procedure, shows limited improvements in the AHI, so it should generally not be recommended for treatment of OSA.