Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a common disorder that can have a significant negative impact on quality of life and health, including many neurologic disorders. This article discusses the updates in the diagnosis, implications, and treatment of OSA.

New recommended criteria for diagnosing OSA increase the recognition of the disorder. Although the apnea-hypopnea index has been the metric used to diagnose, stratify severity, and monitor treatment, it has limitations. A growing number of other metrics, including hypoxic burden, sleep quality, arousal index, respiratory event duration, and daytime sleepiness, are important to consider for comprehensive assessment and risk stratification. Various endotypes and phenotypes of OSA may have certain risks and respond differently to treatment. Treatment of OSA may improve several neurologic symptoms and reduce the risk of neurologic comorbidities. Although positive airway pressure therapy remains the most efficacious treatment of OSA, several alternatives are available, and the list is rapidly expanding, including hypoglossal nerve stimulation and medications.

Neurologists should screen for signs and symptoms of OSA as well as consider testing in patients at high risk who are asymptomatic. Treatment should be tailored based on the severity of OSA, objective data such as the arousal index and hypoxic burden, symptoms, comorbidities, and several patient factors, including morphologic characteristics and personal preferences. OSA is a treatable condition that, when well-managed, may lead to improvement of many neurologic conditions and quality of life.