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SLEEP
MEDICINE

Sleep Apnea

By David Marks, MD

O bstructive sleep apnea (OSA) is a com-

mon and serious sleep disorder that re-
peatedly causes abnormal breathing
patterns or pauses in breathing during sleep. It is
estimated that OSA affects nearly 30 million
1
adults in the U.S. The current prevalence rate of
OSA is about 10-20 percent of middle-aged
adults, with at least 4-8 percent of men and 2-4
2
percent of women. In the general adult popula-
tion, 80-90 percent of OSA is untreated and un-
diagnosed. OSA is secondary to complete or
partial airway obstruction caused by recurrent
pharyngeal collapse during sleep manifesting as
loud snoring or choking with frequent sleep awak-
enings. Individuals suffering from OSA will expe-
rience a wide array of complaints to include loud
snoring, witnessed pauses in breathing, non-
restorative sleep, morning headaches, morning dry
mouth and excessive daytime fatigue. The conse-
quences of untreated OSA are wide ranging and
are thought to result from intermittent
hypoxia/hypercapnia, intrathoracic pressure vari-
ations, fragmented sleep and increased sympa-
thetic nervous activity. Untreated OSA patients
are at an increased risk of developing cardiovascu-
lar disease, metabolic dysregulation and increased
healthcare utilization.
The American Academy of Sleep Medicine has
recently released updated quality measures for the
care of adult patients with obstructive sleep apnea focusing on improve- neck circumference and gender). In the initial validation study, a score
5
ment of detection and categorization of OSA symptoms and severity of at least 3 demonstrated a sensitivity of 84 percent to detect OSA.
3
to promote assessment and diagnosis of the disorder. There are several The diagnosis of OSA is accomplished either by a home sleep study
OSA screening measurements to include the Berlin questionnaire, Ep- (HST) or an in-laboratory diagnostic polysomnography (PSG). The
worth sleepiness scale and STOP-Bang. The Epworth sleepiness scale, American Academy of Sleep Medicine (AASM) has published recent
6
first developed by Dr. Johns, is an 8 categorical scale evaluating subjec- guidance regarding sleep apnea diagnostic testing. A technically ade-
tive sleepiness. It is suggestive that a score of 8 or more has a 76 percent quate home sleep apnea testing device is appropriate for most uncom-
4
sensitivity for the presence of OSA. The STOP-Bang questionnaire plicated adult patients for the diagnosis of OSA. HST is less sensitive
was developed as an OSA screening tool consisting of four self-re- than PSG in the detection of OSA and a false negative test could result
portable traits (snoring, tiredness, observed apnea and high blood pres- in harm to the patient due to denial of a beneficial therapy. In the event
sure) and four demographic criteria to include body mass index, age, of a single negative, inconclusive or technically inadequate HST result,

12 SAN ANTONIO MEDICINE • March 2024