Obstructive sleep apnea & related disorders

OSAS, a common cause of disrupted sleep and EDS, result from

repetitive closure of the upper airway during sleep. It

probably represents the most severe syndrome related to

obstruction of the upper airway; less severe forms include

UARS, a syndrome characterized by the need for increased

effort to breath but no prominent apneas or hypopneas, and

primary snoring. Initial clues to the presence of OSAS and

related disorders are derived from the history and include

loud snoring, EDS or insomnia, and witnessed apneas. Some

patients, especially women, may complain mostly of tiredness

or fatigue, and children may present with behavioral


Obesity, a large neck circumference, and a

crowded oropharynx are common on physical examination.

Nonobese patients, in particular, often have retrognathia, a

high-arched narrow palate, macroglossia, enlarged tonsils,

temporomandibular joint abnormalities, or chronic nasal

obstruction. The clinical suspicion of obstructed nocturnal

breathing is confirmed by overnight polysomnography, and an

MSLT may be used to assess sleepiness. Esophageal manometry

during polysomnography facilitates diagnosis of UARS.

Treatment most commonly consists of nasal CPAP or BPAP,

although problems with compliance make surgical treatment

preferable in some cases.

Although UPPP eliminates sleep

apnea only in a minority of patients, combining UPPP with

maxillofacial procedures appears to improve outcomes. Other

treatments such as the use of dental appliances or

medications, weight loss, and positional therapy may be

useful as adjunctive therapy for moderate to severe OSAS or

as primary treatments for UARS or mild OSAS.

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