Sleep Apnea, Obstructive
- Obstructive sleep apnea (OSA) is defined as repetitive episodes of cessation of airflow (apnea) through the nose and mouth during sleep due to obstruction at the level of the pharynx.
- Apneas often terminate with a snort/gasp.
- Repetitive apneas produce sleep disruption, leading to excessive daytime sleepiness (EDS).
- Associated with oxygen desaturation and nocturnal hypoxemia
- Usual course is chronic.
- System(s) affected: cardiovascular; nervous; pulmonary
- Synonym(s): sleep apnea syndrome; nocturnal upper airway occlusion
- Predominant age: middle-aged men and women
- Predominant sex: male > female (2:1)
- Up to 15% in men; 5% in women
- Prevalence is higher in obese/hypertensive patients.
Etiology and Pathophysiology
OSA occurs when the naso- or oropharynx collapses passively during inspiration. Anatomic and neuromuscular factors contribute to pharyngeal collapse, which leads to hypoxic arousal.
- Anatomic abnormalities, such as increased soft tissue in the palate, tonsillar hypertrophy, macroglossia, and craniofacial abnormalities, predispose the airway to collapse by decreasing the area of the upper airway or increasing the pressure surrounding the airway.
- During sleep, decreased muscle tone in the naso- or oropharynx contributes to airway obstruction and collapse.
- Upper airway narrowing may be due to the following:
- Obesity, redundant tissue in the soft palate
- Enlarged tonsils/uvula or a low soft palate
- Large/posteriorly located tongue
- Craniofacial abnormalities or neuromuscular disorders
- Alcohol/sedative use before bedtime
- Obesity (strongest risk factor)
- Age >40 years
- Alcohol/sedative intake before bedtime
- Nasal obstruction (due to polyps, rhinitis, or deviated septum)
- Anatomic narrowing of nasopharynx (e.g., tonsillar hypertrophy, macroglossia, micrognathia, retrognathia, craniofacial abnormalities)
- Neurologic syndromes (e.g., muscular dystrophy, cerebral palsy)
Weight control and avoidance of alcohol and sedatives at night can help to prevent airway collapse.
Commonly Associated Conditions
- Daytime sleepiness
- Metabolic syndrome
- Cardiac arrhythmias
- Cardiovascular disease
- Congestive heart failure
- Pulmonary hypertension
- Nasal obstructive problems
There's more to see -- the rest of this topic is available only to subscribers.
Domino, Frank J., et al., editors. "Sleep Apnea, Obstructive." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688681/all/Sleep_Apnea__Obstructive.
Sleep Apnea, Obstructive. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688681/all/Sleep_Apnea__Obstructive. Accessed May 29, 2023.
Sleep Apnea, Obstructive. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688681/all/Sleep_Apnea__Obstructive
Sleep Apnea, Obstructive [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 May 29]. Available from: https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688681/all/Sleep_Apnea__Obstructive.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Sleep Apnea, Obstructive ID - 1688681 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688681/all/Sleep_Apnea__Obstructive PB - Wolters Kluwer ET - 27 DB - 5-Minute Clinical Consult DP - Unbound Medicine ER -