Obstructive Sleep Apnea: A Pathophysiology and Pharmacotherapy Approach

Abstract

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by complete cessation of upper airflow during sleep, leading to repetitive episodes of desaturations and arousals. The symptoms include excessive daytime somnolence and are associated with a significant cardiovascular morbidity and mortality. The prevalence of OSA is higher in men with an approximate rate of 14 and 5% in women respectively. Typical risk factors for obstructive sleep apnea in the normal adult population are obesity, aging, gender, menopause, ethnicity, genetical predisposition, craniofacial anatomy, smoking, alcohol consumption and some other factors such as REM sleep, surface tension, and impaired sensory processing. Several screening questionnaires can be performed in outpatient settings to identify the patient symptoms. Polysomnography is considered as the gold standard for diagnosis of OSA. Different surgical treatments and devices are readily available for an effective management of this disease. Proper diagnosis and treatment improves not only the quality of life but also relatively decreases patient morbidity and mortality. A multifaceted approach is necessary for an accurate management of the OSA.

Difficult intubation predictors in obstructive sleep apnea patient

“… Symptoms of OSA: Snoring, repeated breaks in breathing, excess somnolence during the day, morning headache, restlessness and depression or irritability [14,15] .  Signs of OSA: loud snoring, observing periodic stoppage of breathing during sleep, sudden awakening associated with gasping or choking, waking up with dryness of mouth or sore throat, morning headaches, excessive daytime sleepiness, poor concentration during the daytime, altered mood, increased ABP and accentuated P2 heart sounds (pulmonary hypertension) [12] .…”

“… Screening tools: [STOP-BANG questionnaire, Epworth Sleepiness Scale (ESS) and Berlin Questionnaire), polysomnography (PSG)] [16,17] .  Complications of OSA: Daytime fatigue and sleepiness, hypertension, DM, cardiovascular problem, depression and anxiety, difficult airway postoperative complication [intensive care unit (ICU) admission, confusion, pneumonia, bleeding and prolonged hospitalization and sleep-deprived partners [15,18,19] .…”

Association between Obstructive Sleep Apnea and Glaucoma

“…It is characterized by intermittent hypoxemia and arousal due to recurrent episodes of complete upper airway collapse during sleep. 4) OSA is associated with various adverse health outcomes including cardiovascular diseases, metabolic disorders, and neurocognitive impairment. 5) Given the shared risk factors of OSA and glaucoma, including old age, obesity, and systemic comorbidities, the potential association between the two conditions has gained attention in recent years.…”

Interrelationships Between the Posterior Pharyngeal Space and the Dento-Maxillary Anomalies

“…Usually sleep apnea is the result of several factors that are in succession, such as a domino effect (Lowe, 1990) (eg the patient has excess adenoid tissue, the patient to be able to breathe becomes an oral respirator, the tongue is positioned down on the jaw , the tongue thus positioned increases the chances of obstructing the pharynx during the night causing sleep apnea) (Jyothi et al 2019). In order to observe the size changes of the pharyngeal posterior space, we perform lateral teleradiographs, for which we have various analyzes (McNamara, Rickets, etc.)…”