Cited by 1,482Obstructive Sleep Apnea ResearchSleep and related disordersNeuroscience of respiration and sleep

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Diagnosis and Management of Obstructive Sleep Apnea: A Review

Gottlieb, Daniel J., Punjabi, Naresh M.·2020·JAMA

DOI 10.1001/jama.2020.3514

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Abstract

Importance: Obstructive sleep apnea (OSA) affects 17% of women and 34% of men in the US and has a similar prevalence in other countries. This review provides an update on the diagnosis and treatment of OSA. Observations: The most common presenting symptom of OSA is excessive sleepiness, although this symptom is reported by as few as 15% to 50% of people with OSA in the general population. OSA is associated with a 2- to 3-fold increased risk of cardiovascular and metabolic disease. In many patients, OSA can be diagnosed with home sleep apnea testing, which has a sensitivity of approximately 80%. Effective treatments include weight loss and exercise, positive airway pressure, oral appliances that hold the jaw forward during sleep, and surgical modification of the pharyngeal soft tissues or facial skeleton to enlarge the upper airway. Hypoglossal nerve stimulation is effective in select patients with a body mass index less than 32. There are currently no effective pharmacological therapies. Treatment with positive airway pressure lowers blood pressure, especially in patients with resistant hypertension; however, randomized clinical trials of OSA treatment have not demonstrated significant benefit on rates of cardiovascular or cerebrovascular events. Conclusions and Relevance: OSA is common and the prevalence is increasing with the increased prevalence of obesity. Daytime sleepiness is among the most common symptoms, but many patients with OSA are asymptomatic. Patients with OSA who are asymptomatic, or whose symptoms are minimally bothersome and pose no apparent risk to driving safety, can be treated with behavioral measures, such as weight loss and exercise. Interventions such as positive airway pressure are recommended for those with excessive sleepiness and resistant hypertension. Managing asymptomatic OSA to reduce cardiovascular and cerebrovascular events is not currently supported by high-quality evidence.

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Diagnosis of Sleep Apnea Syndrome in the Intensive Care Unit: A Case Series of Survivors of Hypercapnic Respiratory Failure
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Evaluating YouTube Videos on Hypoglossal Nerve Stimulation as a Resource for Patients
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“According to recent scientific findings [1,2], millions of people with chronic and psychiatric diseases have sleep-related problems, that are highly correlated with daily life dysfunction and even traffic accidents.”
Background
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“7,8 Cephalometry is a diagnostic instrument that uses X-rays to provide data on the dimension and location of upper airway structures, which can aid in the diagnosis and classification of the severity of OSA.”
Method
Combined Use of Sleep Quality and Duration Is More Closely Associated With Mortality Risk Among Older Adults: A Population-based Kyoto-Kameoka Prospective Cohort Study
Watanabe, D., Yoshida, T., Watanabe, Y., Yamada, Y., Miyachi, M., Kimura, M., & the Kyoto-Kameoka Study Group (2022) · Journal of Epidemiology · doi:10.2188/jea.je20220215 · Cited by 9
“35 In addition, obstructive sleep apnea is characterized by long sleep duration, sleep disturbance, and daytime dysfunction and is also associated with increased risk of mortality and CVD. 36 Thus, obstructive sleep apnea can mediate long sleep duration and mortality risk.”
Background
Caregiver knowledge of obstructive sleep apnoea in Down syndrome
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Insulin Resistance, but Not Obstructive Sleep Apnea Is Associated with Hepatic Steatosis in Chinese Patients with Severe Obesity
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“51,64 It is possible that not all patients with SRB need therapy; indeed, there is evidence that suggests that the level of “harm” should drive the decision.”
Influential
Chinese consensus report on the assessment and management of obstructive sleep apnea in patients with cardiovascular disease: 2024 edition
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Weight Loss for Obstructive Sleep Apnea: Pharmacological and Surgical Management
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“In addition, if abdominal fat, especially visceral fat, accumulates, the chest volume decreases and the functional residual capacity during breathing decreases, which can reduce the quality of sleep [5,8,9].”
Associations between air pollution, intracellular-to-extracellular water distribution, and obstructive sleep apnea manifestations
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Sleep in the Athlete
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Background
Assessing the causal relationship between psychiatric disorders and obstructive sleep apnea: a bidirectional Mendelian randomization
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“This leads to intermittent hypoxia, sympathetic overactivity, sleep fragmentation, and disruption of physiological homeostasis (1).”
Background
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“As the ﬁrst-line treatment for moderate and severe patients with OSA (18), CPAP treatment can eﬀectively reduce the collapse of the upper airway, alleviate hypoxia, and improve clinical symptoms, including snoring and excessive daytime sleepiness (9).”
BackgroundMethodInfluential
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“There are well-established, effective treatments for OSA, including weight loss, continuous positive airway pressure (CPAP), mandibular advancement splints, and upper airway surgery 2 .”
Background
Bone mineral density alteration in obstructive sleep apnea by derived computed tomography screening
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“A number of questionnaire-based screening instruments used in primary care settings, preoperative screenings and research have been developed to better identify people at risk for OSA (Gottlieb & Punjabi, 2020).”
Association of Dietary Approaches to Stop Hypertension (DASH) diet with self-reported sleep-disordered breathing (SDB): a cross-sectional study from China
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“An increasing amount of literature suggested that SDB was associated with adverse health outcomes, including hypertension (2) , diabetes (3) , CVD (4) , stroke (5) and increased all-cause mortality (6) .”
Background
Sleep apnoea and hypoventilation in patients with five major types of muscular dystrophy
Li, L., Umbach, D. M., Li, Y., Halani, P., Shi, M., Ahn, M., Yeung, D., Vaughn, B. V., & Fan, Z. (2023) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2022-001506 · Cited by 9
Long-term trends in body mass index throughout upper airway stimulation treatment: does body mass index matter?
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Authors: Gottlieb, D. J., & Punjabi, N. M.
Affiliations: Brigham and Women's Hospital (US)
Johns Hopkins University (US)
ORCID: Gottlieb, Daniel J.
Punjabi, Naresh M.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2020-04-14
Volume: 323
Issue: 14
Pages: 1389
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2020.3514
OpenAlex: W3015537361
Semantic Scholar: 0172e9c7f7ea58bd5623bd24ef5636cfe5f6c7df
Cited by: 1,482
References: 112
Citations by year: 2026: 266 · 2025: 330 · 2024: 287 · 2023: 230 · 2022: 225 · 2021: 109 · 2020: 32
FWCI: 19.00
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Funders: National Heart, Lung, and Blood Institute (R01HL146709, R01HL137234)
National Institute of Nursing Research (R01NR018335)
National Institute of Diabetes and Digestive and Kidney Diseases (U34DK120051)
Topics: Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
Keywords: obstructive sleep apnea, sleep apnea diagnosis, home sleep apnea testing, positive airway pressure, oral appliances, hypoglossal nerve stimulation, weight loss, physical activity, obesity, daytime sleepiness, resistant hypertension, cardiovascular risk, cerebrovascular risk, pharyngeal surgery, pharmacotherapy
MeSH terms: Female, Humans, Male, Prognosis, Risk Factors, Weight Loss, Health Behavior, Exercise, Mandibular Advancement, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure

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Diagnosis and Management of Obstructive Sleep Apnea: A Review

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