OSAS, with a prevalence of 4% in adults, represents the most common chronic respiratory disorder after asthma.
The condition is fundamentally caused by an inability of the UA-dilating muscles to withstand the collapsing forces generated during inspiration.
Patients typically present with a triad of symptoms: snoring, witnessed apnoea and daytime sleepiness, in addition to other clinical features.
The most common physical morbidity of OSAS is cardiovascular disease, and successful therapy improves these outcomes.
While the gold-standard diagnosis is sleep laboratory-based polysomnography, increasing attention is being focused on limited cardiorespiratory studies, particularly in the home.
Most patients with OSAS are best managed by nasal CPAP, particularly in moderate to severe cases, and the improvements achieved can be dramatic, particularly in daytime alertness.
To provide a broad overview of OSAS, particularly from a clinical perspective.
To review the basic mechanisms of the disorder and provide a brief introduction to some of the emerging concepts concerning molecular mechanisms of cardiac dysfunction in OSAS patients.
To provide practical information for the clinician on the optimum approach to diagnosis and treatment of the disorder.
Summary OSAS is characterised by recurring episodes of UA obstruction during sleep. Apnoeas are usually terminated by brief arousals, which result in marked sleep fragmentation, and contribute significantly to the symptoms of EDS and cognitive dysfunction. OSAS is also an independent risk factor for cardiovascular disease. The prevalence of OSAS is in the region of 2–4% of the adult population, and this high prevalence creates logistical difficulties in diagnosis.
This review aims to a give a broad overview of OSAS for the clinician, whilst providing practical information concerning the diagnosis and treatment of the disease, including nasal CPAP for the management of moderate to mild OSAS, and weight loss, alcohol avoidance, relief of nasal congestion and keeping the patient off their back in milder cases. The possibility of using a mandibular-advancement device is also discussed.
- ©ERS 2005
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