Obstructive sleep apnea
Obstructive sleep apnea is a "disorder characterized by recurrent apneas during sleep despite persistent respiratory efforts. It is due to upper airway obstruction. The respiratory pauses may induce hypercapnia or hypoxia. Cardiac arrhythmias and elevation of systemic and pulmonary arterial pressures may occur. Frequent partial arousals occur throughout sleep, resulting in relative sleep deprivation and daytime tiredness. Associated conditions include obesity; acromegaly; myxedema; micrognathia; myotonic dystrophy; adenotonsilar dystrophy; and neuromuscular diseases. (From Adams et al., Principles of Neurology, 6th ed, p395)."[1][2]
Diagnosis
Age, body mass index, male sex, and snoring are the best predictors of sleep apnea.[3] However, obstructive sleep apnea is difficult to diagnose based on the history and physical examinations.
A score of more than 5 on the Berlin Questinnaire has a sensitivity of 86%.[4] Clinical prediction rules are available to help diagnose sleep apnea.[5]
Polysomnography is the best test and abnormal is a apnea–hypopnea index of 5 or greater. This test is not always required to diagnose sleep apnea.[6]
References
- ↑ Anonymous (2024), Obstructive sleep apnea (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Caples SM, Gami AS, Somers VK. Obstructive sleep apnea. Ann Intern Med. 2005 Feb 1;142(3):187-97. PMID 15684207
- ↑ Viner S, Szalai JP, Hoffstein V. Are history and physical examination a good screening test for sleep apnea? Ann Intern Med. 1991 Sep 1;115(5):356-9. PMID 1863025
- ↑ Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91. PMID 10507956
- ↑ Rodsutti J, Hensley M, Thakkinstian A, D'Este C, Attia J. A clinical decision rule to prioritize polysomnography in patients with suspected sleep apnea. Sleep. 2004 Jun 15;27(4):694-9. PMID 15283004
- ↑ Mulgrew AT, Fox N, Ayas NT, Ryan CF. Diagnosis and initial management of obstructive sleep apnea without polysomnography: a randomized validation study. Ann Intern Med. 2007 Feb 6;146(3):157-66. PMID 17283346