Elsevier

Mayo Clinic Proceedings

Volume 78, Issue 12, December 2003, Pages 1545-1552
Mayo Clinic Proceedings

Concise Review for Clinicians
Obstructive Sleep Apnea-Hypopnea Syndrome

https://doi.org/10.4065/78.12.1545Get rights and content

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by repetitive episodes of airflow reduction (hypopnea) or cessation (apnea) due to upper airway collapse during sleep. Increasing recognition and a greater understanding of the scope of this condition have substantially affected the practices of many clinicians. This review provides practical information for physicians assessing patients with OSAHS. It discusses complications, clinical recognition, the polysomnographic report, and treatment of OSAHS, including strategies for troubleshooting problems associated with continuous positive airway pressure therapy.

Section snippets

Neurobehavioral and Social

Excessive daytime sleepiness, impaired vigilance, mood disturbances, and cognitive dysfunction are features of OSAHS. Accordingly, pretreatment personal and public health ramifications include increased risk for motor vehicle crashes, occupational injuries, and decreased quality of life.5 Performance deficits during neuropsychological testing can be documented with even mild OSAHS. With a frequency of 15 apneas-hypopneas per hour of sleep, the decrement is equivalent to that associated with 5

History and Physical Examination

The history focuses on breathing disturbances during sleep, unsatisfactory sleep quality, daytime dysfunction, and OSAHS risk factors. A collateral history should be obtained from the patient's bed partner. Reports of habitual, socially disruptive snoring and witnessed apneas terminated by snorts or gasps increase diagnostic accuracy. Sleepiness lacks diagnostic sensitivity and specificity (Table 1). The onset of sleepiness may be so insidious that the patient is unaware of its development, and

LABORATORY DIAGNOSIS OF OSAHS

The diagnosis of OSAHS is based on an integration of clinical information and laboratory testing. The recommended diagnostic test for sleep-related breathing disorders is polysomnography.20 The standard polysomnogram is a laboratory-based, technician-attended multimodality recording of sleep architecture by electroencephalography, electro-oculography, and electromyography; respiratory activity by nasal and oral airflow or pressure, thoracoabdominal inductance plethysmography, and oximetry;

TREATMENT OF OSAHS

Obstructive sleep apnea-hypopnea syndrome is a chronic disease that requires patient education, alleviation of upper airway obstruction, and ongoing follow-up with adjustment of treatment strategies to ensure efficacy. Because many patients with OSAHS are overweight or have comorbid cardiovascular risk factors or diseases, they must be informed of the interaction of OSAHS and overall health. Prospective data on the cardiovascular and perioperative benefits of OSAHS treatment are emerging, but

CONCLUSION

Even mild OSAHS can be associated with pronounced behavioral, social, and cardiovascular morbidity. Thus, it is not surprising that patients with untreated OSAHS have higher health care utilization rates and incur greater medical costs.42 Further data are needed to define the specific cardiovascular risks of untreated OSAHS and to determine the extent of the impact of treatment. Clinicians should suspect OSAHS in patients with habitually loud snoring; witnessed apneas, choking, or gasping

Questions About OSAHS

  • 1.

    Which one of the following is not independently associated with untreated OSAHS?

    • a.

      Systemic hypertension

    • b.

      Stroke

    • c.

      Motor vehicle crash

    • d.

      Excessive daytime sleepiness

    • e.

      Fibromyalgia

  • 2.

    Which one of the following statements is falseregarding recognition of OSAHS?

    • a.

      Prevalence of OSAHS rises inevitably each year after age 65 years

    • b.

      Snoring and sleepiness are not specific for OSAHS

    • c.

      OSAHS is an underappreciated component of the preoperative evaluation

    • d.

      Neck circumference of 43 cm or greater correlates with

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