Approach to obstructive sleep apnea

OBJECTIVE: To provide primary care physicians with up-to-date information on obstructive sleep apnea (OSA) and current management options. SOURCES OF INFORMATION: Reviews of relevant literature retrieved via the PubMed and MEDLINE databases with no date limitations. Searches for the impact on OSA of dentures with implant oral restoration. MAIN MESSAGE: A narrowing of the upper airway axial surface due to fat deposition or hypertrophic tonsils and upper airway neuromuscular pathology can cause OSA. OSA can be asymptomatic, but most patients develop a variety of symptoms, including nocturnal awakenings, nocturia, unrefreshing sleep, daytime sleepiness and fatigue, impaired concentration, and chronic morning headaches. Several screening tools exist, including the Berlin Questionnaire. Laboratory polysomnography (level 1) is the accepted standard for the evaluation of sleep-disordered breathing. Addressing modifiable risk factors can help control OSA. Obesity and overweight status in the adult population, which can be addressed with behavioural interventions, are associated with severity of OSA. Medical options include positive airway pressure (PAP) therapy. Mandibular advancement devices are an alternative for patients with mild or moderate OSA or those who cannot tolerate PAP therapy. Surgical options can address both the biomechanical aspects of OSA and patients' overweight status. CONCLUSION: Careful history-taking and understanding of the underlying biomechanical pathophysiology can orient physicians to consider OSA. Personalized and interdisciplinary approaches should be considered when prescribing OSA treatment and during follow-up assessments.