Diagnosis and Treatment of Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a common disorder in middle-aged adults that remains underrecognized and underdiagnosed in the community. Symptomatology and patient characteristics such as obesity and hypertension increase the clinical likelihood of OSA, but the diagnosis of OSA requires confirmation by overnight polysomnography. Portable, unattended monitoring systems promise a more cost-effective alternative to polysomnography, but their efficacy in the diagnosis of OSA is still unclear. The decision to treat patients with OSA is based on the integration of the objective severity of disease, the presence of cardiovascular risk factors, and the severity of daytime symptoms. Treatment of OSA should aim to abolish all apneic activity and arousals because of respiratory events and to normalize sleep architecture because of upper airways obstruction. Conservative measures such as weight loss and alcohol avoidance are advisable for all patients. Nasal continuous positive airway pressure is the treatment of choice for moderate to severe OSA, but patient acceptance and compliance remain suboptimal. Site-specific surgery such as uvulopalatopharyngoplasty may be useful in selected patients, but there is no reliable test at present to localize the site of obstruction preoperatively and to predict treatment success. The recent introduction of oral appliances provides a treatment option for mild to moderate OSA patients who cannot tolerate continuous positive airway pressure; however, long-term efficacy is unknown.