Adult obstructive sleep apnea

Obstructive sleep apnea (OSA) is a sleep disordered breathing condition characterized by recurrent upper airway collapse. The resultant repetitive hypoxemia, arousals from sleep, and other effects are associated with several adverse health effects including systemic hypertension, cardiac arrhythmias, heart failure, pulmonary hypertension, stroke, and diabetes. Daytime sleepiness and neuropsychiatric effects of OSA are also a considerable burden to patients. Prevalence of OSA is high with an estimated global case load nearing 1 billion. Lab based polysomnography is still considered the gold standard for the diagnosis of OSA. In recent years, the use of home-based sleep apnea testing has increased and has been incorporated in to the American Academy of Sleep Medicine's recommended clinical algorithm for testing and treatment of OSA. The cornerstone of treatment remains positive airway pressure devices along with weight loss and risk factor modifications. Continuous positive airway pressure (CPAP) treatment has been consistently shown to lower blood pressure, reduce sleepiness, and is associated with improvements in heart failure metrics and readmission rates. OSA refractory to CPAP treatment may need bilevel positive airway pressure devices. Additionally, a variety of surgical interventions targeting the oropharynx and surrounding structures are available and can be considered in selected patients. Most surgeries still result in a degree of residual OSA for most patients. A recent innovation in the surgical realm is the ability to implant a hypoglossal nerve stimulator, which stimulates the genioglossus muscle to modulate airway collapsibility. Many advances have been made in our understanding of OSA with concomitant technological advances leading to several treatment options; nevertheless, research opportunities abound in understanding the pathogenesis and consequences of OSA as well the effects on these consequences with therapy.