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Obstructive sleep apnea in adults

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 15 May 2025
Last updated: 11 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • obesity
  • male sex
  • maxillomandibular anomalies
  • excessive daytime sleepiness
  • episodes of apnea
  • episodic gasping
  • restless sleep
  • insomnia
  • macroglossia
  • chronic snoring
Full details

Other diagnostic factors

  • cardiovascular disease
  • weight gain
  • large neck circumference
  • endocrine disorders
  • history of difficult intubation for general anesthesia; obstruction during sedation
  • family history of OSA or snoring
  • history of mucopolysaccharidoses
  • history of GERD
  • history of Down 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
Full details

Risk factors

  • obesity
  • male sex
  • postmenopause (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 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
Full details

Diagnostic tests

1st tests to order

  • attended polysomnography (PSG)
  • unattended nonlaboratory PSG
  • portable multichannel home sleep tests
  • awake fiberoptic endoscopy
Full details

Emerging tests

  • dynamic MRI
  • drug-induced sleep endoscopy (DISE)
  • machine learning

Treatment algorithm

ACUTE

Apnea-Hypopnea Index (AHI) or Respiratory Event Index (REI) of ≥30 episodes/hour: no discrete anatomic lesions

AHI or REI of ≥5 but <30 episodes/hour: no discrete anatomic lesions

AHI or REI of ≥5 episodes/hour with discrete anatomic lesions

ONGOING

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 Aerin Medical, LivaNova, Deerfield Catalyst, and Nyxoah. OJ has received research support from LivaNova for 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 apnea. Zsquare has developed endoscopy systems. OJ is an author of a paper cited in this topic.

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Academy of Sleep Medicine. The AASM International classification of sleep disorders – third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication].Full text

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.Full text  Abstract

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.Full text  Abstract

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.Full text  Abstract

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.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • Differentials

    • Central sleep apnea and Cheyne-Stokes respiration (CSB)
    • Narcolepsy
    • Insufficient sleep
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  • Guidelines

    • International classification of sleep disorders, 3rd edition, text revision (ICSD-3-TR)
    • Sleep-disordered breathing and cardiac arrhythmias in adults: mechanistic insights and clinical implications: a scientific statement
    More Guidelines

  • Patient information

    Sleep apnea in adults (obstructive)

    More Patient information

  • Calculators

    Epworth Sleepiness Scale (ESS)

    More Calculators
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