Adult Obstructive Sleep Apnoea

Perspective:

The following are 10 points to remember about adult obstructive sleep apnea:

1. Obstructive sleep apnoea is a common disorder of repeated upper airway collapse during sleep, leading to oxygen desaturation and disrupted sleep.

2. The prevalence of obstructive sleep apnea was reported in a landmark 1993 Wisconsin Sleep Cohort Study to be 4% in middle-aged men and 2% in middle-aged women (ages 30-60 years). As a result of worsening obesity and improved technology, subsequent studies have reported higher prevalence.

3. Features include snoring, witnessed apneas during sleep, and sleepiness; however, not all adults diagnosed with sleep apnea will complain of sleepiness.

4. Risks for obstructive sleep apnea include: obesity, male sex, age, smoking, menopause, fluid retention, and adenotonsillar hypertrophy.

5. The best test for obstructive sleep apnea is overnight polysomnography in a laboratory with the primary outcome measure of apnea–hypopnea index (number of apneas plus hypopneas per hour of sleep).

6. Nasal continuous positive airway pressure is the treatment of choice. Adherence rates of 60–70% can be improved with intensive education, nasal decongestants, or heated humidification for those with nasal difficulties or with type of device (nasal, face, or nasal pillow masks).

7. Although sleep apnea leads to systemic hypertension and treatment of the condition reduces systemic blood pressure, the relation between hard cardiovascular outcomes and obstructive sleep apnea remains unproven.

8. Randomized controlled trials of continuous positive airway pressure are difficult to do for both ethical and logistical reasons, which explains why there are no clear data showing that continuous positive airway pressure prevents myocardial infarction, congestive heart failure, or stroke.

9. Obstructive sleep apnea increases the risk of motor vehicle accidents up to 7 times compared to people without the condition.

10. Sedatives used to treat insomnia should be used cautiously in patients with obstructive sleep apnea.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Hypertension, Sleep Apnea

Keywords: Prevalence, Menopause, Snoring, Polysomnography, Wisconsin, Continuous Positive Airway Pressure, Nasal Decongestants, Blood Pressure, Obesity, Hypertension, Sleep Apnea Syndromes


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