Clinical presentations of obstructive sleep apnea syndrome

https://doi.org/10.1053/pcad.1999.0410331Get rights and content

Abstract

Obstructive sleep apnea syndrome (OSAS) is a common but still underrecognized disorder. It affects 2% to 4% of middle-aged adults, a significant proportion of whom are female. The spectrum of clinical presentations of OSAS and their severity is variable, ranging from neurocognitive complaints to cardiorespiratory failure. OSAS has a significant impact on quality of life, cardiovascular morbidity, and mortality. Its major sequelae include daytime somnolence and its consequences (motor vehicle accidents, poor work performance, disrupted social interactions), systemic and pulmonary hypertension, and ischemic heart disease. Treatment of OSAS results in improvement in symptoms, quality of life, and blood pressure control, and may improve mortality. An expansion of our understanding of this condition has resulted in increased awareness of its consequences, but the recognition of OSAS in clinical practice is still delayed. Identification of these patients in clinical practice requires attention to risk factors (history of snoring and witnessed apneas, obesity, increased neck circumference, hypertension, family history) and careful examination of the upper airway. Clinical impression alone, however, has poor (50% to 60%) sensitivity and specificity (63% to 70%) and the diagnosis is usually obtained on polysomnography. Physicians and other health care professionals need to be aware of the progress made in this area and recognize the necessity for prompt evaluation and treatment of these patients. Copyright © 1999 by W.B. Saunders Company

Progress in Cardiovascular Diseases, Vol. 41, No. 5 (March/April), 1999: pp 331-340

Section snippets

Definitions

Obstructive Apnea-Hypopnea Syndrome (OSAS) is a clinical diagnosis confirmed by polysomnography (PSG). Although certain clinical features of the syndrome are suggestive, the diagnosis should in almost all cases be confirmed by PSG, which requires an overnight stay in the sleep laboratory with monitoring of sleep stages (electroencephalogram [EEG], electrooculogram [EOG], and electromyogram [EMG]), respiratory effort, air flow, electrocardiogram [ECG], oxygen saturation, and body position and

Presentation

OSAS is a chronic condition with an insidious onset and a wide spectrum of clinical presentations. At one end are asymptomatic patients referred because of occasional witnessed apneas; at the other are severely somnolent patients with cardiac or respiratory failure. Neurocognitive complaints may prompt a referral to a psychiatrist; surgical treatment of snoring may be pursued if other complaints suggestive of sleep apnea are not elicited.

Summary

OSAS is a common disorder that, if not recognized and treated, leads to significant morbidity and increased mortality. Some of the reported underrecognition of OSAS in the general population may be attributable not only to lack of physician and patient awareness but also to a variety of ways in which this condition can present. Physicians need to be aware that OSAS is no longer recognized as an almost exclusively male syndrome and that often the florid respiratory failure and severe daytime

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    Copyright © 1999 W.B. Saunders Company. All rights reserved.