Last reviewed: 20 Sep 2020
Last updated: 15 Oct 2020

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
More 1st investigations to order

Emerging tests

  • cine MRI
  • drug-induced sleep endoscopy (DISE)
  • cardiovascular and neurological tests
  • biochemical or genetic signatures and assays
More emerging tests

Treatment algorithm

Contributors

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 reviewersVIEW ALL

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.

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.

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