Obstructive sleep apnoea in adults

Symptoms of obstructive sleep apnoea include loud snoring, gasping during sleep, apnoeas, unrefreshing sleep, and excessive daytime sleepiness.

Obesity, retro- or micrognathia, oropharyngeal narrowing, and macroglossia are common physical features.

Diagnosis is established using clinical evaluation plus polysomnography or portable sleep tests.

Positive airway pressure or oral appliances are non-invasive treatment options.

In patients unable to adhere to medical therapy or with discrete anatomical sites of obstruction, soft tissue and/or skeletal surgery may be selected for treatment of obstructive sleep apnoea.

Complications of untreated obstructive sleep apnoea include increased risk of premature death, myocardial infarction, dysrhythmias, stroke, hypertension, motor vehicle accidents, metabolic syndrome, and neurocognitive dysfunction.

Complications of continuous positive airway pressure treatment include sleep disturbance, rhinitis, dermatitis, conjunctivitis, aerophagia, and dyspnoea. Complications of oral appliance therapy include occlusal changes and facial pain. Complications of surgery include bleeding, haematoma, velopharyngeal insufficiency, pharyngeal stenosis, dysphagia, airway obstruction, and, very rarely, death.

Obstructive sleep apnoea (OSA) is characterised by episodes of complete or partial upper airway obstruction during sleep. Episodic airway obstruction is usually associated with oxyhaemoglobin desaturations and arousals from sleep. The symptoms of sleep apnoea include chronic snoring, insomnia, gasping and breath holding, unrefreshing sleep, and daytime sleepiness.[1]American Academy of Sleep Medicine. ICSD-2 international classification of sleep disorders, 2nd ed: diagnostic and coding manual. Westchester, IL: American Academy of Sleep Medicine, 2005.

The diagnosis of OSA may be confirmed if the Apnoea-Hypopnoea Index (the sum per hour of episodes of apnoeas and hypopnoeas) or Respiratory Distress Index (the sum per hour of episodes of apnoea, hypopnoea, and respiratory effort-related arousals) established with polysomnography or portable sleep test is ≥15 episodes/hour. However, 5 episodes/hour is considered sufficient for diagnosis if additional symptoms or comorbidities are present.