Obstructive Sleep Apnea in Adults: Common Questions and Answers

Gawrys, Breanna DO
Silva, Taran W. DO
Herness, Joel MD

BREANNA GAWRYS, DO, FAAFP, DipABLM, is associate program director of the David Grant USAF Medical Center Family Medicine Residency Program, Travis Air Force Base, Calif.; an associate professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md.; and an associate professor of family medicine at the University of California Davis School of Medicine.
TARAN W. SILVA, DO, is faculty at the David Grant USAF Medical Center Family Medicine Residency Program, and an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences.
JOEL HERNESS, MD, FAAFP, is faculty at the David Grant USAF Medical Center Family Medicine Residency Program, and an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences.

Author disclosure: No relevant financial relationships.

This article updates previous articles on this topic by Semelka, et al.; Victor; and Victor.

Data Sources: A PubMed search was completed in Clinical Queries using the key terms obstructive sleep apnea with incidence, prevalence, prevention, comorbidities, diagnostic mimics, morbidity, mortality, practice guidelines, therapy, diagnosis, and treatment. The search included meta-analyses, randomized controlled trials, clinical trials, clinical practice guidelines, and reviews. The Agency for Healthcare Research and Quality Effective Healthcare Reports, the Cochrane database, DynaMed, and Essential Evidence Plus were also searched. Search dates: May 4 to July 4, 2023, and May 2, 2024.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Air Force, the Uniformed Services University of the Health Sciences, the U.S. Department of Defense, or the U.S. government.

American Family Physician 110(1):p 27-36, July 2024.

Obstructive sleep apnea (OSA) is a common disorder that affects quality of life and is associated with comorbidities such as hypertension, atrial fibrillation, heart failure, coronary heart disease, type 2 diabetes mellitus, and stroke. OSA is characterized by a reduction or cessation of breathing during sleep, resulting in intermittent hypoxemia, autonomic fluctuation, and sleep fragmentation. The U.S. Preventive Services Task Force states that there is insufficient evidence to recommend routine screening for OSA in the absence of symptoms. OSA should be considered in patients with excessive daytime fatigue, unrestful sleep, persistent snoring, and nocturnal awakenings with gasping or choking. The STOP-BANG questionnaire is the most sensitive screening tool for OSA, and the diagnostic standard is polysomnography with an observed apnea-hypopnea index greater than 5 in the presence of symptoms or greater than 15 without symptoms. Home sleep apnea testing is a useful diagnostic option in patients who have symptoms consistent with moderate to severe OSA without significant cardiopulmonary comorbidities. Positive airway pressure, with a humidified nasal or facial mask, is the first-line treatment for adults with OSA. Weight loss is a beneficial adjunct to treatment through intensive lifestyle modification, medications, or bariatric surgery. Alternatives for patients intolerant of or nonadherent to positive airway pressure include changing the type of mask used, mandibular advancement devices, hypoglossal nerve stimulation, and other surgical interventions. Although many OSA therapies effectively improve daytime sleepiness and blood pressure, none have demonstrated a mortality benefit in randomized controlled trials.