Summary
Definition
History and exam
Key diagnostic factors
- obesity
- male sex
- maxillomandibular anomalies
- excessive daytime sleepiness
- episodes of apnoea
- episodic gasping
- restless sleep
- insomnia
- macroglossia
- chronic snoring
Other diagnostic factors
- cardiovascular disease
- weight gain
- large neck circumference
- endocrine disorders
- history of difficult intubation for general anaesthesia
- family history of OSA or snoring
- history of mucopolysaccharidoses
- history of GORD
- history of Down's syndrome
- history of tooth extractions for crowding
- history of motor vehicle accidents
- neurocognitive dysfunction
- mood disorders
- nocturia
- erectile dysfunction
- morning headaches
- heartburn/dyspepsia
- dry mouth
- nocturnal sweating
Risk factors
- obesity
- male sex
- post-menopause (women)
- large neck circumference
- maxillomandibular anomalies (e.g., narrowing, retrognathia, and high, arched palate)
- increased volume of soft tissues (includes tonsils, adenoids, and tongue)
- family history of OSA
- chronic snoring
- nasal obstruction
- polycystic ovary syndrome
- levels of sex hormones
- hypothyroidism
- Down's syndrome
- mucopolysaccharidoses
- alcohol use
- increasing age
- black, Hispanic, and Asian ethnicity
- tobacco smoking
Diagnostic investigations
1st investigations to order
- polysomnography (PSG)
- portable multichannel sleep tests
- awake fibreoptic endoscopy
Emerging tests
- cine MRI
- drug-induced sleep endoscopy (DISE)
- cardiovascular and neurological tests
- biochemical or genetic signatures and assays
Treatment algorithm
Apnoea-Hypopnoea Index (AHI) or Respiratory Event Index (REI) of ≥30 episodes/hour: no discrete anatomical lesions
AHI or REI of ≥5 but <30 episodes/hour: no discrete anatomical lesions
AHI or REI of ≥5 episodes/hour with discrete anatomical lesions
persistent postoperative OSA
Contributors
Authors
Ofer Jacobowitz, MD, PhD, FAASM
Co-director of Sleep
ENT and Allergy Associates
Associate Professor
Department of Otolaryngology
Northwell/Zucker School of Medicine, Hofstra University
New York
NY
Disclosures
OJ is a scientific consultant for, and has received a consulting fee from, LivaNova and Nyxoah. OJ has received research support from LivaNova for US Food and Drug Administration trial research. Both LivaNova and Nyxoah have developed implantable neurostimulation systems for obstructive sleep apnoea.
Peer reviewers
Carla Daltro, MD
Professor of Medicine
Bahiana School of Medicine and Public Health
Brazil
Disclosures
CD has been reimbursed by Sanofi-Aventis, Novartis, Merck Sharp Dohme, and Eli Lilly as an investigator of clinical trials.
Krishna M. Sundar, MD
Adjunct Assistant Professor
University of Utah
Director
Pulmonary & Critical Care Research
IHC Urban South Intermountain Utah Valley Pulmonary Clinic
Provo
UT
Disclosures
KMS declares that he has no competing interests.
Differentials
- Central sleep apnoea and Cheyne-Stokes respiration (CSB)
- Narcolepsy
- Insufficient sleep
More DifferentialsGuidelines
- Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome
- Treatment of adult obstructive sleep apnea with positive airway pressure
More GuidelinesPatient leaflets
Sleep apnoea in adults (obstructive)
More Patient leafletsCalculators
Epworth Sleepiness Scale (ESS)
More CalculatorsLog in or subscribe to access all of BMJ Best Practice
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