Obstructive Sleep Apnea: Considerations for the Primary Care Practitioner
Hedges, Marilyn J.
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Obstructive sleep apnea (OSA) affects millions of American each year and is the most serious of the sleep disorders in terms of morbidity and mortality. Numerous studies have linked OSA to increased risk of hypertension, stroke, myocardial infarction, motor vehicle accidents, and cognitive and social impairment. OSA is caused by collapse or obstruction of the upper airway during sleep, which leads to frequent nocturnal arousals and sleep fragmentation. Patients usually present with a history of chronic snoring and daytime hypersomnolence. Children with OSA commonly snore but may not have daytime sleepiness. OSA can lead to poor growth and behavioral problems in children. Previous studies on adults have shown that daytime hypersomnolence, obesity, increased neck circumference, male gender, and hypertension are strongly associated with obstructive sleep apnea. In the present study, 20 clinical indicators taken from a questionnaire completed by 131 patients referred for OSA, were analyzed and correlated to the apnea-hypopnea index, or degree of OSA. Neck circumference, male gender, hypertension, and daytime hypersomnolence were found to have statistically significant correlations to OSA, thus substantiating prior research. Diagnosis of obstructive sleep apnea is based on overnight polysomnography, which measures sleep staging, the number of obstructive respiratory events per hour, and other physiological parameters. The treatment of choice for adults is nasal continuous positive airway pressure (CPAP), a mask and blower device that is worn during sleep and acts as a pneumatic splint. Though research has shown CPAP to be effective and safe, patient compliance remains an issue. Behavioral changes, particularly lateral positioning during sleep, weight loss, and avoidance of alcohol and sedatives are beneficial. Limited success has been achieved with pharyngeal surgery, medications, and dental appliances. In children, adenotonsillectomy is usually effective. Recommendations for the practitioner include particular awareness of these clinical indicators when making patient assessments, as well as patient education and supportive follow up in order to successfully treat patients suffering from this serious sleep disorder.