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Apnea obstructiva del sueño en adultos

  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Última revisión: 24 Sep 2025
Última actualización: 11 Dec 2024

Resumen

Definition

History and exam

Key diagnostic factors

  • obesidad
  • sexo masculino
  • alteraciones maxilomandibulares
  • somnolencia diurna excesiva
  • episodios de apnea
  • jadeo episódico
  • sueño inquieto
  • insomnio
  • macroglosia
  • ronquidos crónicos
Full details

Other diagnostic factors

  • enfermedad cardiovascular
  • aumento de peso
  • circunferencia del cuello grande
  • enfermedades del sistema endocrino
  • antecedentes de intubación difícil para anestesia general; obstrucción durante la sedación
  • antecedentes familiares de AOS o de ronquidos
  • antecedentes de mucopolisacaridosis
  • antecedentes de ERGE
  • antecedentes de síndrome de Down
  • antecedentes de extracciones dentales por apiñamiento de la dentición
  • antecedentes de accidentes automovilísticos
  • disfunción neurocognitiva
  • trastornos del estado de ánimo
  • nicturia
  • disfunción eréctil
  • cefaleas matinales
  • acidez/dispepsia
  • boca seca
  • sudoración nocturna
Full details

Risk factors

  • obesidad
  • sexo masculino
  • posmenopausia (mujeres)
  • circunferencia del cuello grande
  • alteraciones maxilomandibulares (p. ej., estrechamiento, retrognatia y paladar arqueado alto)
  • aumento del volumen de los tejidos blandos (incluidas las amígdalas, vegetaciones y lengua)
  • antecedentes familiares de AOS
  • ronquidos crónicos
  • síndrome del ovario poliquístico (SOPQ)
  • hipotiroidismo.
  • síndrome de Down
  • mucopolisacaridosis
  • mayor edad
  • raza negra, hispana o asiática
  • tabaquismo
  • obstrucción nasal
  • niveles de hormonas sexuales
  • consumo de alcohol
  • exposición al humo del tabaco ambiental
  • uso de opioides
Full details

Diagnostic tests

1st tests to order

  • polisomnografía asistida (PSG)
  • PSG desatendido y no de laboratorio
  • pruebas de sueño caseras multicanal portátiles
  • fibroendoscopia con el paciente despierto
Full details

Emerging tests

  • IRM dinámica
  • endoscopia del sueño mediante sedación inducida por fármacos (DISE)
  • aprendizaje automático

Treatment algorithm

ACUTE

índice de apnea-hipopnea (IAH) o índice de eventos respiratorios (RDI) ≥30 episodios/hora: sin lesiones anatómicas aisladas

IAH o REI ≥5 pero <30 episodios/hora: sin lesiones anatómicas aisladas

IAH o REI ≥5 episodios/hora con lesiones anatómicas aisladas

ONGOING

apnea obstructiva del sueño (AOS) postoperatoria persistente

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 US 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 apnoea. 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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

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

    • Apnea del sueño central y respiración de Cheyne-Stokes (CSB)
    • Narcolepsia
    • Sueño insuficiente
    More Differentials

  • 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 apnoea in adults (obstructive)

    More Patient information

  • Calculators

    Escala de somnolencia de Epworth (ESE)

    More Calculators
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