Obstructive sleep apnoea in adults
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; obstruction during sedation
- 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
- polycystic ovary syndrome (PCOS)
- hypothyroidism
- Down's syndrome
- mucopolysaccharidoses
- increasing age
- black, Hispanic, or Asian ethnicity
- tobacco smoking
- nasal obstruction
- levels of sex hormones
- alcohol use
- environmental tobacco smoke exposure
- opioid use
Diagnostic tests
1st tests to order
- attended polysomnography (PSG)
- unattended non-laboratory PSG
- portable multichannel home sleep tests
- awake fibreoptic endoscopy
Emerging tests
- dynamic MRI
- drug-induced sleep endoscopy (DISE)
- machine learning
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 post-operative 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 Aerin Medical, LivaNova, Deerfield Catalyst, and Nyxoah. OJ has received research support from LivaNova for US Food and Drug Administration trial research. Aerin Medical has developed nasal valve treatment devices for nasal obstruction. Both LivaNova and Nyxoah have developed implantable neurostimulation systems for obstructive sleep apnoea. Zsquare has developed endoscopy systems. OJ is an author of a paper cited in this topic.
Revisores
Carla Daltro, MD
Professor of Medicine
Bahiana School of Medicine and Public Health
Brazil
Declarações
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
Declarações
KMS declares that he has no competing interests.
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Declarações
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Referências
Principais artigos
American Academy of Sleep Medicine. The AASM International classification of sleep disorders – third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication].Texto completo
Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017 Mar 15;13(3):479-504.Texto completo Resumo
Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline. Sleep. 2019 Feb 15;15(2):335-43.Texto completo Resumo
Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021 Jul 20;144(3):e56-67.Texto completo Resumo
Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015 Jul 15;11(7):773-827.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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