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.