Obstructive Sleep Apnea: Clinical Presentation & Diagnosis

Apr 03, 2020
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OSA or Obstructive sleep apnea is the most common type of sleep apnea and is characterized by what causes the stop or pause on breathing, in this case, a muscle may be blocking the air path. It shows repeated episodes of complete or partial obstructions of the upper airway during sleep, despite the effort to breathe, and is usually associated with a reduction in blood oxygen saturation.

The prevalence of OSA in the general adult population varies depending on the definition but is approximately 15 to 30 percent in males and 5 to 15 percent in females (when OSA is defined as an apnea-hypopnea index [AHI] greater than five events per hour of sleep)

Top Risk Factors Of OBS

It is said that anyone can develop sleep apnea, but these conditions may add up to the factor that you might have these and condition may be more serious:

Older Age - The prevalence of OSA increases from young adulthood through the sixth to seventh decade, then appears to plateau.

Male Gender - According to studies male are more prone from 2 to 3 times greater than women but when a woman reaches its postmenopausal era the risk is the same.

Obesity & Hypoventilation Syndrome - This is associated with the soft tissue of the mouth and throat. During sleep, when throat and tongue muscles are more relaxed, this soft tissue can cause the airway to become blocked. But many other factors also are associated with the condition in adults.

Craniofacial & Upper Airway Abnormalities - a smaller mandible is a risk factor for OSA and the previously observed inferiorly positioned hyoid bone in apnoeic is associated with enlarged tongue volume.

Smoking - Cigarette smoking may increase the severity of OSA through alterations in sleep architecture, upper airway neuromuscular function, arousal mechanisms, and upper airway inflammation.

Family History of Snoring or OSA - There are studies that genes and previous family members in history of OSA can add to the risk factor.

Nasal Congestion - This causes the upper airway to narrow, increases the risk of both snoring and OSA among allergic rhinitis patients

Here are more factors that can add to the risk of having OBS:

Pregnancy

End-stage Kidney Disease,

Congestive Heart Failure,

Chronic Lung Disease,

Type 2 Diabetes

Mellitus

Stroke

Acromegaly

Hypothyroidism

Polycystic Ovary Syndrome

Floppy Eyelid Syndrome

Symptoms & Differential Diagnosis

People with OSA often feel these symptoms:

Daytime Sleepiness
Loud snoring
Gasping
Choking
Snorting
Interruptions In Breathing

Daytime sleepiness is not just fatigued it's marked by heavy eyelids during the day and nodding off when you want to stay awake this is the main concern of people with OSA. More in the list are resuscitative gasping or snorting, witnessed apneic periods, periods of silence followed by loud snoring, restless or fitful sleep.

Diagnosis

Recommend diagnostic testing in patients who have excessive daytime sleepiness and two out of three of the following: habitual snoring, witnessed apnea, gasping, or choking during sleep, or diagnosed hypertension. We also frequently perform testing in patients who have excessive daytime sleepiness alone, patients who have other clinical features of OSA and associated conditions or complications (eg, refractory hypertension), and patients in whom OSA needs to be ruled in or out as an underlying cause or potential contributing factor to their symptoms (eg, unexplained pulmonary hypertension or motor vehicle accident due to falling asleep). Evaluation tools or questionnaires (eg, ESS, Berlin, STOP-Bang questionnaires) are not typically used to select patients for diagnostic testing since they are inaccurate and have not been shown to be superior to a good history and physical examination.

Reference:

https://www.uptodate.com/