Overview of obstructive sleep apnea in adults

INTRODUCTION

Obstructive sleep apnea (OSA) is a common chronic disorder that often requires lifelong care [1]. Cardinal features in adults include:

  • Obstructive apneas, hypopneas, or respiratory effort related arousals.
  • Daytime symptoms attributable to disrupted sleep, such as sleepiness, fatigue, or poor concentration.
  • Signs of disturbed sleep, such as snoring, restlessness, or resuscitative snorts.

OSA is an important disorder because patients are at increased risk for poor neurocognitive performance and medical disorders, due to repeated arousals and/or hypoxemia during sleep over months to years. The severity and duration of OSA necessary for development of these sequelae vary among individuals [2]. In addition, severe untreated OSA has been associated with increased all-cause and cardiovascular mortality.

The epidemiology, risk factors, pathophysiology, and outcome of OSA in adults are reviewed here. The definition, clinical presentation, diagnosis, and treatment are discussed in detail elsewhere. (See "Clinical presentation and diagnosis of obstructive sleep apnea in adults" and "Management of obstructive sleep apnea in adults".)

EPIDEMIOLOGY

It is estimated that up to 26 percent of adults are at high risk for OSA [3,4]. The prevalence of OSA in general North American populations is approximately 20 percent if defined as an apnea hypopnea index (AHI) greater than five events per hour (the AHI is the number of apneas and hypopneas per hour of sleep) [3]. In contrast, it is 2 to 9 percent if defined as an AHI greater than five events per hour accompanied by at least one symptom that is known to respond to treatment (eg, daytime sleepiness) [3,5]. Therefore, it is common to be minimally symptomatic and have an AHI in an abnormal range.

            

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: Apr 2013. | This topic last updated: Feb 12, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5:263.
  2. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA 2004; 291:2013.
  3. Young T, Palta M, Dempsey J, et al. Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. WMJ 2009; 108:246.
  4. Jennum P, Riha RL. Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing. Eur Respir J 2009; 33:907.
  5. Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of sleep apnea. Physiol Rev 2010; 90:47.
  6. Redline S, Tishler PV. The genetics of sleep apnea. Sleep Med Rev 2000; 4:583.
  7. Marshall NS, Wong KK, Liu PY, et al. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep 2008; 31:1079.
  8. Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 2009; 6:e1000132.
  9. Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease: an American Heart Association/american College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation 2008; 118:1080.
  10. Gottlieb DJ, Yenokyan G, Newman AB, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation 2010; 122:352.
  11. Loke YK, Brown JW, Kwok CS, et al. Association of obstructive sleep apnea with risk of serious cardiovascular events: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2012; 5:720.
  12. Yaggi HK, Concato J, Kernan WN, et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005; 353:2034.
  13. Mokhlesi B, Kryger MH, Grunstein RR. Assessment and management of patients with obesity hypoventilation syndrome. Proc Am Thorac Soc 2008; 5:218.
  14. Martinez CH, Han MK. Contribution of the environment and comorbidities to chronic obstructive pulmonary disease phenotypes. Med Clin North Am 2012; 96:713.
  15. Lancaster LH, Mason WR, Parnell JA, et al. Obstructive sleep apnea is common in idiopathic pulmonary fibrosis. Chest 2009; 136:772.
  16. Yaffe K, Laffan AM, Harrison SL, et al. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA 2011; 306:613.
  17. Lin WC, Winkelman JW. Obstructive sleep apnea and severe mental illness: evolution and consequences. Curr Psychiatry Rep 2012; 14:503.
  18. Strohl, K, Bonnie, R, Findley, L, et al. Sleep apnea, sleepiness and driving risk. American Journal of Respiratory and Critical Care Medicine 1999; 150:1463.
  19. Giles TL, Lasserson TJ, Smith BH, et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2006; :CD001106.
  20. George CF. Sleep apnea, alertness, and motor vehicle crashes. Am J Respir Crit Care Med 2007; 176:954.
  21. Leger D, Bayon V, Laaban JP, Philip P. Impact of sleep apnea on economics. Sleep Med Rev 2012; 16:455.