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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Minerva Pneumologica 2004 June;43(2):63-78
The obstructive sleep apnea/hypopnea syndrome in adults. Diagnosis and management
Littner M. R.
The obstructive sleep apnea/hypopnea syndrome is a prevalent medical disorder that is associated with multiple health-related consequences including daytime sleepiness, reduced quality of life, cardiovascular disease and increased mortality. Patients have complete (apnea) or partial (hypopnea) occlusion of the trachea from collapse of the soft tissues of the pharynx during sleep. The prevalence of the disorder is estimated at between 2% and 4% of individuals between 30 and 60 years of age. The prevalence increases with age and appears to level off after age 65. The typical patient is obese, male and snores loudly. However, women, particularly those who are postmenopausal, may also have the disorder. While many patients present classically, there are less obvious forms of the disorder with mostly snoring and arousals during sleep leading to many of the usual consequences. Diagnosis is made with an overnight sleep study. The gold standard test is the polysomnogram which is attended by a technician. Sleep stages, respiratory events (apneas, hypopneas, and arousals associated with increased respiratory effort from partial airway obstruction) and leg movement are routinely monitored. The gold standard for treatment is attended continuous positive airway pressure (CPAP) titration, usually administered through the nose, under polysomnographic monitoring. Other approaches to diagnosis include monitoring respiratory events alone either attended or unattended. Alternatives to one night of diagnosis and one night of CPAP titration include diagnosis and titration in one night (split-night study) which is also a standard approach, and less standard approaches of CPAP titration with attended respiratory monitoring (no sleep staging) or unattended titration using an auto-titrating CPAP machine. Alternative therapies include a dental appliance or surgery to enlarge the oropharynx. Treatment leads to reduced daytime sleepiness, improved quality of life and possibly reduced mortality.