Adult Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent upper airway collapse during sleep resulting in inadequate ventilation and subsequent acute gas exchange abnormalities and sleep fragmentation. OSA is associated with myriad cardiovascular, metabolic, and neurobehavioral consequences. Upper airway patency is determined by the interplay of many factors, including upper airway anatomy and neuromuscular function. The diagnosis of OSA is based on the integration of clinical factors, such as habitual snoring, snort arousals, witnessed apneas, nonrestorative sleep, daytime sleepiness, body habitus, and crowded oropharynx as well as sleep testing via polysomnography in the laboratory or at home. The most efficacious treatment is continuous positive airway pressure, but problems with patient adherence are common. Risk factor modifications, oral appliances, and upper airway surgical procedures are additional options. Pediatric OSA, central sleep apnea, and other conditions associated with hypoxemia/hypoventilation in sleep and their management are discussed elsewhere in the Encyclopedia.