Obstructive sleep apnea in adults

Symptoms 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 anatomical sites of obstruction, soft tissue and/or skeletal surgery may be selected for treatment of obstructive sleep apnea.

Complications of untreated obstructive sleep apnea include increased risk of premature death, MI, dysrhythmias, stroke, HTN, motor vehicle accidents, metabolic syndrome, and neurocognitive dysfunction.

Complications of continuous positive airway pressure (CPAP) treatment include sleep disturbance, rhinitis, dermatitis, conjunctivitis, aerophagia, and dyspnea. Complications of oral appliance therapy include occlusal changes and facial pain. Complications of surgery include bleeding, hematoma, velopharyngeal insufficiency, pharyngeal stenosis, dysphagia, airway obstruction, and, very rarely, death.

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. ICSD-2 international classification of sleep disorders, 2nd ed: diagnostic and coding manual. Westchester, IL: American Academy of Sleep Medicine, 2005.

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 additional symptoms or comorbidities are present.