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Postgrad Med J 89:148-156 doi:10.1136/postgradmedj-2012-131340
  • Reviews

Obstructive sleep apnoea in adults

  1. R Doug McEvoy1,4,5
  1. 1Adelaide Institute for Sleep Health, Repatriation General Hospital, Adelaide, South Australia, Australia
  2. 2Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
  3. 3Department of Respiratory Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
  4. 4School of Medicine, Flinders University, Adelaide, South Australia, Australia
  5. 5Discipline of Physiology, School of Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
  1. Correspondence to Dr Zafar Ahmad Usmani, Department of Respiratory Medicine, The Queen Elizabeth Hospital, 4A, TQEH, 28 Woodville Road, Woodville South, Adelaide, South Australia 5011, Australia; zafar-ahmad.usmani{at}health.sa.gov.au
  • Received 25 July 2012
  • Revised 19 September 2012
  • Accepted 14 October 2012
  • Published Online First 17 November 2012

Abstract

Obstructive sleep apnoea (OSA) is characterised by repetitive closure of the upper airway, repetitive oxygen desaturations and sleep fragmentation. The prevalence of adult OSA is increasing because of a worldwide increase in obesity and the ageing of populations. OSA presents with a variety of symptoms the most prominent of which are snoring and daytime tiredness. Interestingly though, a significant proportion of OSA sufferers report little or no daytime symptoms. OSA has been associated with an increased risk of cardiovascular disease, cognitive abnormalities and mental health problems. Randomised controlled trial evidence is awaited to confirm a causal relationship between OSA and these various disorders. The gold standard diagnostic investigation for OSA is overnight laboratory-based polysomnography (sleep study), however, ambulatory models of care incorporating screening questionnaires and home sleep studies have been recently evaluated and are now being incorporated into routine clinical practice. Patients with OSA are very often obese and exhibit a range of comorbidities, such as hypertension, depression and diabetes. Management, therefore, needs to be based on a multidisciplinary and holistic approach which includes lifestyle modifications. Continuous positive airway pressure (CPAP) is the first-line therapy for severe OSA. Oral appliances should be considered in patients with mild or moderate disease, or in those unable to tolerate CPAP. New, minimally invasive surgical techniques are currently being developed to achieve better patient outcomes and reduce surgical morbidity. Successful long-term management of OSA requires careful patient education, enlistment of the family's support and the adoption of self-management and patient goal-setting principles.


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