Obstructive sleep apnea syndrome (OSA) management

Obstructive sleep apnea syndrome (OSA) management

Obstructive sleep apnea (OSA) is characterized by episodes of complete or partial collapse of the upper airway with an associated decrease in oxygen saturation or arousal from sleep.

OSA is a sleep disorder that involves cessation or significant reduction in airflow despite continued breathing effort.

Clinical presentation

Sleep-related symptoms

• Loud snoring

• Restless sleep

• Insomnia

Daytime symptoms

• Daytime sleepiness

• Morning headaches

• Trouble concentrating

• Forgetfulness

• Mood changes such as:

  • Irritability

  • Anxiety

  • Depression

Cardiometabolic manifestations

• Increased heart rate

• Increased blood pressure

• Unexplained weight gain

Genitourinary manifestations

• Increased urination

• Nocturia

Gastrointestinal manifestations

• Heartburn

• Gastro-oesophageal reflux disease (GERD)

Other symptoms

• Decreased sex drive

• Heavy night sweats

Investigations

• Nocturnal polysomnography

• Thyrotropin test

• Cysteine levels

• Multiple Sleep Latency Test (MSLT)

• Maintenance of Wakefulness Test (MWT)

Non-pharmacological treatment

Lifestyle modification

• Avoid alcohol.

• Avoid sleeping pills.

• Avoid other sedative medications.

Positive airway pressure therapy

• Continuous positive airway pressure (CPAP)

Oral appliances

• Mandibular advancement splint

Pharmacological treatment

Acetazolamide

• Acetazolamide (PO) 500 mg–1 g every 24 hours for 3–5 days

Surgical intervention

• Maxillomandibular advancement

• Tonsillectomy

• Uvulopalatopharyngoplasty (UPPP)