Diagnosis and Management of Obstructive Sleep Apnea

Abstract

ImportanceObstructive sleep apnea (OSA) affects 17% of women and 34% of men in the US and has a similar prevalence in other countries. This review provides an update on the diagnosis and treatment of OSA.ObservationsThe most common presenting symptom of OSA is excessive sleepiness, although this symptom is reported by as few as 15% to 50% of people with OSA in the general population. OSA is associated with a 2- to 3-fold increased risk of cardiovascular and metabolic disease. In many patients, OSA can be diagnosed with home sleep apnea testing, which has a sensitivity of approximately 80%. Effective treatments include weight loss and exercise, positive airway pressure, oral appliances that hold the jaw forward during sleep, and surgical modification of the pharyngeal soft tissues or facial skeleton to enlarge the upper airway. Hypoglossal nerve stimulation is effective in select patients with a body mass index less than 32. There are currently no effective pharmacological therapies. Treatment with positive airway pressure lowers blood pressure, especially in patients with resistant hypertension; however, randomized clinical trials of OSA treatment have not demonstrated significant benefit on rates of cardiovascular or cerebrovascular events.Conclusions and RelevanceOSA is common and the prevalence is increasing with the increased prevalence of obesity. Daytime sleepiness is among the most common symptoms, but many patients with OSA are asymptomatic. Patients with OSA who are asymptomatic, or whose symptoms are minimally bothersome and pose no apparent risk to driving safety, can be treated with behavioral measures, such as weight loss and exercise. Interventions such as positive airway pressure are recommended for those with excessive sleepiness and resistant hypertension. Managing asymptomatic OSA to reduce cardiovascular and cerebrovascular events is not currently supported by high-quality evidence.

Health-Related Quality of Life and Sleep Quality after 12 Months of Treatment in Nonsevere Obstructive Sleep Apnea: A Randomized Clinical Trial with Continuous Positive Airway Pressure and Mandibular Advancement Splints

“…compliance with treatment is a known challenge in the treatment of nonsevere OSA, especially in CPAP treatment [38,50]; so, lower compliance in the CPAP than in the MAS treatment group could be expected [23,26]. However, the compliance with CPAP in this study was lower than expected [51][52][53][54]. Discomfort related to the CPAP mask, choking sensation, and xerostomia were the most reported reasons for noncompliance.…”

Targeted Metabolomics Analysis on Obstructive Sleep Apnea Patients after Multilevel Sleep Surgery

“…As a result, an improved understanding of OSA-associated risk with T2D and other chronic diseases is critical because OSA can be treated with various procedures. Multiple treatment modalities exist for OSA, including weight loss in overweight people, CPAP, oral devices, as well as surgeries, such as bariatric and upper airway surgeries (such as MLS) [ 4 , 5 , 6 ]. The most effective surgical procedure to reduce AHI in MLS is tonsillectomy.…”

“…OSA can also be estimated using the Epworth Sleeping Scale (ESS), which is a subjective self-administered questionnaire that estimates the daytime sleepiness by responding to the likelihood (0–3 points) of falling asleep while involved in eight different daily activities. Multiple treatment modalities exist for OSA, including weight loss for overweight people, continuous positive airway pressure (CPAP), oral devices, as well as surgeries such as bariatric and upper airway surgeries [ 4 , 5 , 6 ]. OSA usually involves one or more upper airway levels.…”

High prevalence for obesity in severe COVID-19: Possible links and perspectives towards patient stratification

“…Body weight excess is a well-established respiratory disease risk factor, especially for sleep apnea [30], and the reported correlation between obesity and severe cases of COVID-19 infection is therefore unsurprising. The underlying pathophysiology is likely multistranded, ranging from complement system hyperactivation, increased interleukin-6 and interferon secretion, chronic inflammation, presence of comorbidities such as diabetes and hypertension, and a local mechanical deleterious effect of fat accumulation in the chest.…”