Obstructive sleep apnea syndrome: natural history, diagnosis, and emerging treatment options

Abstract

Sleep apnea is an entity characterized by repetitive upper airway obstruction resulting in nocturnal hypoxia and sleep fragmentation. It is estimated that 2%–4% of the middle-aged population has sleep apnea with a predilection in men relative to women. Risk factors of sleep apnea include obesity, gender, age, menopause, familial factors, craniofacial abnormalities, and alcohol. Sleep apnea has been increasingly recognized as a major health burden associated with hypertension and increased risk of cardiovascular disease and death. Increased airway collapsibility and derangement in ventilatory control responses are the major pathological features of this disorder. Polysomnography (PSG) is the gold-standard method for diagnosis of sleep apnea and assessment of sleep apnea severity; however, portable sleep monitoring has a diagnostic role in the setting of high pretest probability sleep apnea in the absence of significant comorbidity. Positive pressure therapy is the mainstay therapy of sleep apnea. Other treatment modalities, such as upper airway surgery or oral appliances, may be used for the treatment of sleep apnea in select cases. In this review, we focus on describing the sleep apnea definition, risk factor profile, underlying pathophysiologic mechanisms, associated adverse consequences, diagnostic modalities, and treatment strategies.

Association of sleep apnea and sleep duration with peripheral artery disease: The Multi-Ethnic Study of Atherosclerosis (MESA)

“…Polysomnography is the gold-standard method for the assessment of OSA[52]. Studies based on self-report have limitations in accuracy, and OSA is known to be underdiagnosed in the community [52]. Likelihood of receiving an OSA diagnosis may also have been dependent on access to health care; in our sample those self-reporting OSA tended to have greater educational attainment.…”

“…Fourth, for the prospective analyses sleep apnea and habitual snoring were self-reported, thus misclassification almost certainly occurred. Polysomnography is the gold-standard method for the assessment of OSA[52]. Studies based on self-report have limitations in accuracy, and OSA is known to be underdiagnosed in the community [52].…”

Usefulness of Artificial Neural Networks in the Diagnosis and Treatment of Sleep Apnea-Hypopnea Syndrome

“…Currently, CPAP is the primary preferred treatment of mild, moderate, and severe SAHS and thus it is considered the standard of care. During CPAP treatment, a continuous pressure of air is delivered to the patient's upper airway to keep patency [92]. Though nonintrusive, simple, and effective, the device delivers an unnecessary constant high pressure during the whole night whatever the actual patient's needs, which decreases comfort and in turn treatment compliance.…”

Die Analyse von Schnarchen bei Patienten mit obstruktiver Schlafapnoe (OSA) anhand von Polysomnografie und LEOSound

“…Die OSA stellt unter den schlafbezogenen Atmungsstörungen (SBAS) mit einer Prävalenz von 1 -2 % in der Gesamtbevölkerung das häufigste Krankheitsbild dar und ist mit kardiovaskulären Erkrankungen assoziiert [1,2]. Wenn Schnarchen als Symptom der OSA betrachtet wird, weisen 70 -80 % der Patienten, die schnarchen, eine OSA auf.…”