Definition and Diagnosis
Obstructive sleep apnea is a sleep-related breathing disorder characterized by repeated episodes of partial or complete upper airway obstruction during sleep, leading to fragmented sleep, intermittent hypoxia, and excessive daytime sleepiness.
Epidemiology
Obstructive sleep apnea is common, with moderate-to-severe disease estimated to affect around 10-17% of men and 3-9% of women, with prevalence rising with age and obesity.
Risk Factors
Risk factors include obesity, male sex, increasing age, anatomical features such as a narrow airway or large tonsils, family history, smoking, alcohol use, and nasal congestion.
Symptoms and Subtypes
Symptoms include loud snoring, witnessed pauses in breathing during sleep, gasping or choking arousals, morning headaches, and excessive daytime sleepiness, which can impair concentration, mood, and increase accident risk.
Diagnosis
Diagnosis is confirmed with polysomnography (sleep study) or validated home sleep apnea testing, measuring the frequency of apnea and hypopnea events per hour (the apnea-hypopnea index) to determine severity.
Treatment
Continuous positive airway pressure (CPAP) therapy is first-line for moderate-to-severe disease; weight loss, positional therapy, oral appliances, and, in select cases, surgery are additional options depending on severity and anatomy.
Prognosis
With effective treatment, symptoms and associated cardiovascular risk improve substantially; untreated obstructive sleep apnea is associated with hypertension, cardiovascular disease, and increased accident risk due to daytime sleepiness.
Reference
Sadock, B. J., Sadock, V. A., & Ruiz, P. Kaplan & Sadock's Synopsis of Psychiatry (11th ed.).