Obstructive sleep apnea in adults

Symptoms of obstructive sleep apnea (OSA) include loud snoring, gasping during sleep, apneas, 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 noninvasive treatment options.

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

OSA is characterized by episodes of complete or partial upper airway obstruction during sleep. Episodic airway obstruction is usually associated with oxyhemoglobin desaturations and arousals from sleep. The symptoms of sleep apnea include chronic snoring, insomnia, gasping and breath holding, unrefreshing sleep, and daytime sleepiness.[1]American Academy of Sleep Medicine. The AASM International classification of sleep disorders – third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication]. https://aasm.org/clinical-resources/international-classification-sleep-disorders ​​

The diagnosis of OSA may be confirmed if the Apnea-Hypopnea Index (the sum per hour of episodes of apneas and hypopneas) or Respiratory Distress Index (the sum per hour of episodes of apnea, hypopnea, and respiratory effort-related arousals) established with polysomnography or portable sleep test is ≥15 episodes/hour. However, 5 episodes per hour is considered sufficient for diagnosis if significant symptoms or comorbidities are present.