ENT and Head & Neck Surgery
Sleep Apnea and Snoring
OSA diagnosis, CPAP management, oral appliances, and surgical options — focused on daytime sleepiness, comorbid disease risk, and quality of life.
What is sleep apnea and when should it be investigated?
Obstructive sleep apnea (OSA) is a disorder of repeated upper-airway collapse during sleep, with oxygen desaturation and arousals. Loud snoring, witnessed apneas, morning headache, daytime sleepiness, and concentration difficulty are the core symptoms. Polysomnography is the gold-standard diagnostic; the apnea-hypopnea index (AHI) defines severity. Treatment spans CPAP, oral appliances, weight management, and upper-airway surgery (UPPP, hypoglossal nerve stimulation). Untreated OSA increases risk of hypertension, atrial fibrillation, stroke, and metabolic syndrome.
Diagnosis and severity
If clinical suspicion is high, polysomnography (PSG) confirms the diagnosis. Mild OSA: AHI 5–15. Moderate: 15–30. Severe: >30. Upper-airway evaluation (Mallampati score, mandibular retrognathia, tonsil hypertrophy) accompanies diagnosis to inform surgical candidacy.
Home sleep apnea testing (HSAT) is an alternative for selected moderate-to-high probability cases. PSG is preferred when parasomnia or periodic limb movement is suspected.
Treatment options
CPAP (continuous positive airway pressure) is the gold standard; with adherence, it nearly normalises AHI. For non-adherent patients, mandibular advancement devices (effective up to moderate severity), weight management, positional therapy, and surgery are options.
Surgical options: tonsillectomy (large tonsils), uvulopalatopharyngoplasty (UPPP), nasal surgery (concurrent obstruction), and hypoglossal nerve stimulation (Inspire) for advanced cases. Multidisciplinary sleep-centre evaluation is standard.
Frequently Asked Questions
- No. Simple snoring (without apnea) is common and may not need treatment. But heavy snoring with witnessed apneas or daytime sleepiness needs polysomnography.
- Yes. Mandibular advancement device (up to moderate severity), positional therapy, weight management, upper-airway surgery. The CPAP non-adherence cause (mask type, pressure titration) should be optimised first.
- Yes. In children, adenotonsillar hypertrophy is the most common cause. Adenotonsillectomy is curative in 70–80% of paediatric OSA.
- Anatomical causes are permanent; treatment (CPAP, surgery) keeps symptoms controlled. Significant weight loss can resolve OSA in some patients.
- Some OSA-associated resistant hypertension improves with CPAP. General hypertension management should continue.
References
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