Obstructive Sleep Apnea/Hypopnea Syndrome

Obstructive sleep apnea/hypopnea (OSA/H) is a common disorder for which there are a variety of therapeutic options. All patients should make appropriate alterations in lifestyle and habits to reduce the risk of upper airway instability during sleep. The aggressiveness of additional treatment should be dictated by the severity of OSA/H, as measured by the condition's physiologic and clinical impact. At this time, the most compelling reason to treat patients with OSA/H is to reverse daytime sleepiness, functional or performance impairments, and clinically significant hypoxemia. Given data that suggest strong associations between vascular diseases and OSA/H, however, it may be prudent to use a relatively low threshold when deciding whether to treat patients at high risk for hypertension and cardiovascular diseases. Although we do not completely understand the extent to which any given derangement in sleep architecture or sleep-associated gas exchange leads to short- or long-term morbidity, such an abnormality should alert the clinician to the possible need for intervention and the need for careful follow-up. In general, all patients with OSA/H who require treatment should have a trial of continuous positive airway pressure (CPAP), the medical therapy of choice. This approach provides rapid and assured alleviation of OSA/H. Once CPAP therapy is under way, the patient and clinician can evaluate other options if the patient does not wish to continue long-term positive-pressure therapy. It is essential that patients and their caregivers understand the nature of OSA/H and its risk factors and realize that successful upper airway stabilization by means of medical and surgical interventions other than positive pressure or tracheostomy cannot be guaranteed. Surgical techniques cannot guarantee cure and can cause notable adverse consequences. Although it is almost invariably successful in maintaining upper airway patency during sleep, positive-pressure therapy may also have side effects. These generally are not lasting or severe, but they may nonetheless affect patient comfort. Measures are available to address these side effects. Increasing amounts of information support the importance to clinical care of patient education about both OSA/H and its therapy. Such education enhances the likelihood of successful treatment, improved quality of life, and improved long-term outcome.