In obstructive sleep apnea the throat collapses again and again during sleep, cutting off airflow and briefly waking the brain each time. Obesity, a thick neck and male sex raise the risk, and untreated apnea is linked to high blood pressure, atrial fibrillation and car crashes.
Key symptoms
- Loud snoring and witnessed pauses in breathing
- Daytime sleepiness, even falling asleep while driving
- Waking up gasping or choking
- Morning headaches and poor focus
- Waking at night to urinate
What you find on exam
- BMI, neck circumference and blood pressure
- Crowded throat: large tonsils, large tongue, small jaw
- Nasal blockage
- Screening tools such as STOP-BANG and the Epworth sleepiness scale
Tests
- Home sleep apnea test in uncomplicated adults
- In-lab polysomnography if other serious illness is present
- Apnea-hypopnea index: 5 to 14 mild, 15 to 29 moderate, 30 or more severe
Treatment basics
- CPAP every night as first-line therapy
- Weight loss; tirzepatide is approved for sleep apnea with obesity
- No alcohol or sedatives before bed; sleep on the side
- Oral appliance for mild to moderate disease
- Hypoglossal nerve stimulation or surgery for selected patients
Red flags
- Falling asleep while driving
- High carbon dioxide or low oxygen while awake
- Severe apnea with heart failure or arrhythmia
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.