Obstructive Sleep Apnea

Diagnosis

A healthcare professional evaluates your condition based on your symptoms, a physical exam, and specific sleep tests. In many cases, you may be referred to a sleep specialist for further evaluation.

The physical exam includes checking the back of your throat, mouth, and nose for abnormalities. Measurements of your neck and waist circumference are often taken, and your blood pressure may also be checked.

A sleep specialist can diagnose obstructive sleep apnea (OSA) and determine its severity. They can also design a treatment plan tailored to your condition. Diagnosis may involve spending a night at a sleep center or using an at-home sleep test.

Tests commonly used to diagnose obstructive sleep apnea include:

• Polysomnography: This overnight sleep study monitors your heart, lung, and brain activity, as well as breathing patterns, movements, and blood oxygen levels.

  • In some cases, only part of the night is used for monitoring, called a split-night study. If OSA is detected, continuous positive airway pressure (CPAP) therapy may be initiated for the second half of the night.

  • The test can also help rule out other sleep disorders such as periodic limb movement disorder or narcolepsy.

• Home sleep apnea testing: This simplified version of polysomnography monitors limited variables at home to detect breathing pauses during sleep.

Treatment

Effective treatments are available for obstructive sleep apnea that can improve your sleep quality, daytime alertness, and overall health. Treatment also reduces the risk of heart and blood vessel complications.

Therapies

The main therapies for obstructive sleep apnea focus on keeping the airway open during sleep.

• Positive airway pressure (PAP):
  This is the most common and effective treatment for OSA. A machine delivers pressurized air through a mask worn over the nose or mouth to keep the airway open.

  • Continuous Positive Airway Pressure (CPAP): Delivers a steady, constant air pressure that prevents airway collapse. Modern CPAP machines are smaller, quieter, and more comfortable than older models.

  • Auto-titrating Positive Airway Pressure (APAP): Automatically adjusts air pressure throughout the night depending on your breathing patterns.

  • Bilevel Positive Airway Pressure (BPAP): Delivers different pressures when you inhale and exhale, helpful for people who have difficulty tolerating CPAP.

  Some people experience discomfort, bloating, or dryness with PAP therapy. Using a humidifier and experimenting with mask types can help improve comfort.

• Oral appliances:
  Also known as mouth devices, these are used for people with mild to moderate sleep apnea or those who cannot tolerate CPAP.

  • They work by repositioning the lower jaw or tongue to keep the airway open.

  • Devices must be fitted by a dentist experienced in dental sleep medicine.

  • Regular follow-up is needed to ensure proper fit and effectiveness.

  • A newer device using electrical stimulation on the tongue may help in mild cases but is not a replacement for CPAP in moderate to severe sleep apnea.

Surgery or Other Procedures

Surgery is considered when other treatments are ineffective or unsuitable. Surgical procedures aim to remove or reduce obstructions in the airway.

Common surgical options include:

• Uvulopalatopharyngoplasty (UPPP): Removes tissue from the back of the mouth and throat, sometimes including tonsils and adenoids, to widen the airway.

• Nerve stimulation implant: A hypoglossal nerve stimulator is implanted under the skin of the chest. It activates the tongue muscles during inhalation to prevent blockage.

• Jaw surgery (Maxillomandibular advancement): Moves the upper and lower jaws forward to enlarge the airway.

• Tracheostomy: Creates a breathing opening in the neck when other treatments fail and the condition is life-threatening.

Additional surgical approaches may include:

• Nasal surgery to correct a deviated septum or remove nasal polyps

• Tonsil or adenoid removal

• Bariatric surgery for weight reduction in people with obesity

Weight-Loss Medications

Weight management plays an important role in controlling obstructive sleep apnea. Studies show that weight loss medications can significantly improve symptoms. The U.S. Food and Drug Administration has approved tirzepatide (Mounjaro, Zepbound) for treating moderate to severe OSA in combination with diet and exercise.

Even after substantial weight loss, continued follow-up with a healthcare provider is recommended to ensure that sleep apnea is fully managed.