Overview
Definition
A sleep-related breathing disorder characterized by recurrent episodes of complete or partial upper airway obstruction during sleep, resulting in hypoxemia and sleep fragmentation.
Epidemiology
Very common, affecting up to 20% of adults. Strongly associated with obesity.
Etiology & Risk Factors
- Anatomical narrowing of the upper airway (obesity, large tonsils/adenoids in children, macroglossia, retrognathia)
- Decreased upper airway dilator muscle tone during sleep
Clinical Symptoms
- Loud snoring
- Witnessed apneic episodes (gasping/choking during sleep)
- Excessive daytime sleepiness
- Morning headaches
- Unrefreshing sleep
Clinical Approach
Diagnosis
- Polysomnography (Sleep Study - Gold Standard): Apnea-Hypopnea Index (AHI) ≥ 5 events/hour with symptoms, or ≥ 15 events/hour regardless of symptoms
- Home Sleep Apnea Testing (HSAT) is acceptable for uncomplicated patients with high pre-test probability
Management
- Continuous Positive Airway Pressure (CPAP) - first-line therapy
- Weight loss (strongly recommended for all obese patients)
- Avoid alcohol and sedatives before bed
- Oral appliances (mandibular advancement devices) for mild-to-moderate OSA
- Surgical options (UPPP, Maxillomandibular advancement) for refractory cases
Complications
- Resistant Hypertension
- Atrial Fibrillation
- Pulmonary Hypertension / Cor Pulmonale
- Increased risk of Stroke and MI
- Motor vehicle accidents (due to daytime somnolence)