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Diagnosis and Management of Obstructive Sleep ApneaA Review

Educational Objective
To review the diagnosis and management of obstructive sleep apnea.
1 Credit CME

Importance  Obstructive sleep apnea (OSA) affects 17% of women and 34% of men in the US and has a similar prevalence in other countries. This review provides an update on the diagnosis and treatment of OSA.

Observations  The most common presenting symptom of OSA is excessive sleepiness, although this symptom is reported by as few as 15% to 50% of people with OSA in the general population. OSA is associated with a 2- to 3-fold increased risk of cardiovascular and metabolic disease. In many patients, OSA can be diagnosed with home sleep apnea testing, which has a sensitivity of approximately 80%. Effective treatments include weight loss and exercise, positive airway pressure, oral appliances that hold the jaw forward during sleep, and surgical modification of the pharyngeal soft tissues or facial skeleton to enlarge the upper airway. Hypoglossal nerve stimulation is effective in select patients with a body mass index less than 32. There are currently no effective pharmacological therapies. Treatment with positive airway pressure lowers blood pressure, especially in patients with resistant hypertension; however, randomized clinical trials of OSA treatment have not demonstrated significant benefit on rates of cardiovascular or cerebrovascular events.

Conclusions and Relevance  OSA is common and the prevalence is increasing with the increased prevalence of obesity. Daytime sleepiness is among the most common symptoms, but many patients with OSA are asymptomatic. Patients with OSA who are asymptomatic, or whose symptoms are minimally bothersome and pose no apparent risk to driving safety, can be treated with behavioral measures, such as weight loss and exercise. Interventions such as positive airway pressure are recommended for those with excessive sleepiness and resistant hypertension. Managing asymptomatic OSA to reduce cardiovascular and cerebrovascular events is not currently supported by high-quality evidence.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Daniel J. Gottlieb, MD, MPH, VA Boston Healthcare System, 1400 VFW Pkwy (111PI), West Roxbury, MA 02132 (djgottlieb@partners.org).

Accepted for Publication: March 3, 2020.

Conflict of Interest Disclosures: Dr Gottlieb reported receiving research and nonfinancial support from ResMed Inc, outside of the present work. Dr Punjabi reported receiving research and nonfinancial support from ResMed Inc, outside of the present work.

Funding/Support: Dr Gottlieb is supported by National Institutes of Health grants HL137234, DK120051, and NR018335 and by US Department of Veterans Affairs grants CX000578 and BX004821. Dr Punjabi is supported by National Institutes of Health grants HL11716, DK120051, and HL146709.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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