Symptoms of obstructive sleep apnea 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, myocardial infarction, dysrhythmias, stroke, hypertension, motor vehicle accidents, metabolic syndrome, and neurocognitive dysfunction.
Complications of continuous positive airway pressure 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.
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.
History and exam
- cardiovascular disease
- weight gain
- large neck circumference
- endocrine disorders
- history of difficult intubation for general anesthesia
- 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
- erectile dysfunction
- morning headaches
- dry mouth
- nocturnal sweating
- 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
- nasal obstruction
- polycystic ovary syndrome
- levels of sex hormones
- Down syndrome
- alcohol use
- increasing age
- black, Hispanic, or Asian ethnicity
- tobacco smoking
Ofer Jacobowitz, MD, PhD, FAASM
Co-director of Sleep
ENT and Allergy Associates
Department of Otolaryngology
Northwell/Zucker School of Medicine, Hofstra University
OJ is a scientific consultant for, and has received a consulting fee from, LivaNova and Nyxoah. OJ has received research support from LivaNova for Food and Drug Administration trial research. Both LivaNova and Nyxoah have developed implantable neurostimulation systems for obstructive sleep apnea.
Carla Daltro, MD
Professor of Medicine
Bahiana School of Medicine and Public Health
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
Pulmonary & Critical Care Research
IHC Urban South Intermountain Utah Valley Pulmonary Clinic
KMS declares that he has no competing interests.
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