Screening for Obstructive Sleep Apnea in Adults

Abstract

An association of extreme obesity with hypersomnolence was recognized in antiquity and described in the early 19th century in both medical texts and, most famously, in Dickens' Posthumous Papers of the Pickwick Club. However, not until the first polysomnographic recordings of sleep and respiration were made in the 1960s was it recognized that apneas resulting from intermittent obstruction of the upper airway during sleep, causing hypoxemia and cortical arousal, contributed to the excessive sleepiness in these so-called "Pickwickian" patients. 1 The term "obstructive sleep apnea syndrome" was coined the following decade, and it was soon recognized that intermittent partial airway obstruction during sleep, resulting in reduced airflow (hypopnea) without apnea, could result in an identical clinical syndrome.Although obstructive sleep apnea syndrome was initially considered an uncommon condition, epidemiology studies in the 1990s revealed that apneas and hypopneas during sleep are quite common in the general adult population. 2 In 1999 the American Academy of Sleep Medicine (AASM) published a task force report that defined "obstructive sleep apnea-hypopnea syndrome" as a condition characterized by an elevated frequency of apneas and hypopneas during sleep (the apnea-hypopnea index [AHI]) plus bothersome symptoms, most notably excessive sleepiness, fatigue, or unrefreshing sleep. The severity of this syndrome was classified along 2 axes: severity of sleepiness and frequency of obstructive events. 3 Since that time, however, the requirement for symptoms has been largely dropped from the standard sleep disorders nosology: the diagnosis of adult obstructive sleep apnea (OSA) is made if the AHI is 15 or more events per hour of sleep regardless of associated clinical features, while for those with an AHI between 5 and 15 events per hour, the list of associated symptoms, signs, and comorbid conditions supporting the diagnosis of OSA has been expanded to include insomnia symptoms, habitual snoring, hypertension, diabetes, cardiovascular disease, and mood disorder, among others 4 -a list so broad that an AHI of 5 or greater has become a de facto sufficient criterion for diagnosis of OSA.Thus defined, OSA is exceedingly common in the adult population. As of 2010, OSA was conservatively estimated to affect 34% of men and 17% of women between the ages of 30 and 70 years in the US 5 -estimates that would be consid-

Recognition of apnea and hypopnea by non-contact optical fiber mattress and its application in the diagnosis of obstructive sleep apnea hypopnea syndrome: a retrospective study

“…Obstructive sleep apnea hypopnea syndrome (OSAHS) is characterized by apnea or hypopnea during sleep ( Gottlieb, 2022 ). Apnea and hypopnea result in intermittent hypoxia and sleep fragmentation.…”

LncR-GAS5 decrease in adenine phosphoribosyltransferase expresssion via binding TAF1 to increase kidney damage created by CIH

“…Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a sleep-related breathing disorder characterized by snoring and the repetitive collapse of the upper airways, which disrupts normal ventilation [ 1 , 2 ]. OSAHS is associated with multiple comorbidities, including cardiovascular events and chronic kidney disease (CKD).…”

Approach the Patient With Obstructive Sleep Apnea and Obesity

“…Symptoms may include 1 or more of loud snoring, choking, or gasping during sleep, witnessed apneas, fatigue, excessive daytime sleepiness (EDS), morning headaches, difficulty concentrating, mood changes, and irritability. OSA is causally associated with multiple comorbidities ( 2 ).…”