Obstructive sleep apnea (OSA) and excessive sleepiness associated with OSA: recognition in the primary care setting

Obstructive sleep apnea (OSA) is a common and debilitating condition characterized by recurrent episodes of upper airway obstruction, resulting in intermittent occurrence of apnea-hypopnea. Clinical features include snoring or disturbed sleep, reduced concentration and memory, mood disorders, and excessive sleepiness (ES). Left undiagnosed and untreated, OSA may have detrimental consequences, including cardiovascular (CV) morbidity and mortality, decreased health-related quality of life, and increased incidence of motor vehicle accidents. As most individuals affected by OSA will initially present in the primary care setting, primary care physicians have the opportunity to recognize the condition and refer patients for treatment when necessary. Management of the condition should include lifestyle changes and continuous positive airway pressure (CPAP) treatment if required. Wakefulness-promoting agents may be considered if ES persists despite CPAP. Effective intervention for OSA not only provides symptomatic benefits, but also improves hypertension and reduces the risk for fatal and nonfatal CV events associated with the condition.