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Obstructive sleep apnea in adults

Last reviewed: 9 Nov 2024
Last updated: 31 May 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.

  • 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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