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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“There are several known factors for developing OSA and most of them can be categorized into two large groups: anatomic and non-anatomic [2].”
Background
Computational Biomechanics of Sleep: A Systematic Mapping Review
Cheng, E. S.-W., Lai, D. K.-H., Mao, Y.-J., Lee, T. T., Lam, W., Cheung, J. C., & Wong, D. W. (2023) · Bioengineering · doi:10.3390/bioengineering10080917 · Cited by 5
“The former may involve surgeries, oral appliances, and sleep posture therapy for OSA [116,117], while the latter may involve night braces/splints for other musculoskeletal conditions [118,119] or sleep posture and appliances for pregnancy [120].”
Background
Truck collisions attributed to falling asleep at the wheel in two commercial drivers prescribed oral appliance therapy for obstructive sleep apnea
Kumagai, H., Tsuda, H., Kawaguchi, K., Sawatari, H., Kiyohara, Y., Konishi, N., Taniyama, Y., Takaoka, T., & Shiomi, T. (2023) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.10758 · Cited by 5
Cross-Domain Based Deep Neural Network for Obstructive Sleep Apnea Detection via Piezoelectric Ceramic Sensor Array
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“The Lancet Respiratory Medicine reported that 33.9% of men and 17.4% of women in the US aged 30 to 70 years old were with mild OSA, while 13.0% of men and 5.6% of women were with moderate or severe OSA [2].”
BackgroundInfluential
Positive Airway Pressure Therapy Compliance in Patients With Comorbid Insomnia and Sleep Apnea
Bae, M. R., Lee, Y.-H., Lee, S. W., Chung, S., & Chung, Y. (2024) · Clinical and Experimental Otorhinolaryngology · doi:10.21053/ceo.2023.00017 · Cited by 5
“PAP compliance is crucial in preventing complications and improving survival rates among patients with OSA [11].”
Background
Association of self-reported and objective sleep disturbance with the spectrum of gastroesophageal reflux disease
Hu, K.-Y., Tseng, P., Hsu, W., Lee, P., Tu, C., Chen, C.-C., Lee, Y., Chiu, H., Wu, M., & Peng, C. (2024) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.11028 · Cited by 7
Effects of combined exercise training with sleep education in older adults with obstructive sleep apnea: protocol for a randomized clinical trial
Fank, F., Artismo, R. S., Santana, M. G., Esteves, A. M., Matte, D. L., & Mazo, G. Z. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1322545 · Cited by 5
“Positive airway pressure therapy is the primary treatment for individuals with symptomatic OSA of any severity and continuous positive airway pressure (CPAP) is the gold standard among its modalities (Epstein et al., 2009; Gottlieb and Punjabi, 2020; Lee and Sundar, 2021).”
Background
Pathogenesis of Obstructive Sleep Apnea in Obesity
Patil, S. P., & Kirkness, J. P. (2024) · Respiratory medicine · doi:10.1007/978-3-031-52696-1_6 · Cited by 5
Machine Learning Models to Enhance the Berlin Questionnaire Detection of Obstructive Sleep Apnea in at-Risk Patients
Conte, L., Nunzio, G. D., Giombi, F., Lupo, R., Arigliani, C., Leone, F., Salamanca, F., Petrelli, C., Angelelli, P., Benedetto, L. D., et al. (2024) · Applied Sciences · doi:10.3390/app14135959 · Cited by 5
Sleep medicine education in the United States advanced dental education programs
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Obstruktív alvási apnoéban szenvedő betegek jellemzői hazai beteganyagon
Bikov, A., Mészáros, M., & Kunos, L. (2020) · Orvosi Hetilap · doi:10.1556/650.2020.31880 · Cited by 5
“Az OSA és a magasvérnyomás-betegség, a cardiovascularis megbetegedések, a szívritmuszavarok, a cukorbetegség és a zsíranyagcsere zavarai közötti kapcsolat jól ismert [8].”
Sleep Disordered Breathing and Mortality in Patients With Hypertrophic Obstructive Cardiomyopathy Undergoing Septal Myectomy
Cui, H. Z., Schaff, H. V., Somers, V. K., Nishimura, R. A., Dearani, J. A., Geske, J. B., King, K. S., & Ommen, S. R. (2021) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2021.03.036 · Cited by 5
Mediation effect of hypoxia in the relationship between obstructive sleep apnea and cardiovascular death risk
Zhou, Y., Tan, X., Lu, J., & Liu, C. (2022) · Sleep And Breathing · doi:10.1007/s11325-022-02564-8 · Cited by 6
The Weighted Combination of the Epworth Sleepiness Scale and the STOP-Bang Questionnaire Improved the Predictive Value of for OSAHS in Hypertensive Patients
Sun, D., Xu, S., Wang, L., Zhang, L., Yu, H.-Y., & Shen, J.-Q. (2022) · International Journal of General Medicine · doi:10.2147/ijgm.s360544 · Cited by 5
Views on oral health determinants as described by persons with continuous positive airway pressure-treated obstructive sleep apnoea: a qualitative study
Ahonen, H., Neher, M., Fransson, E. I., Broström, A., & Lindmark, U. (2023) · BMC Oral Health · doi:10.1186/s12903-023-03108-6 · Cited by 5
Factors influencing new‐onset hypertension in elderly patients with obstructive sleep apnea: A multicenter cohort study
Zhao, L., Gao, Y., Xu, W., Li, K., Liu, L., & Fan, L. (2023) · Clinical and Translational Science · doi:10.1111/cts.13631 · Cited by 6
Interdisciplinary Role of Orthodontist in Screening and Managing Obstructive Sleep Apnea in Children and Adults
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Coping strategies for obese individuals with obstructive sleep apnea during COVID-19 pandemic: A narrative review
Vaishali, K., Gatty, A. P., Srivastav, P., & Amin, R. (2021) · Obesity Medicine · doi:10.1016/j.obmed.2021.100324 · Cited by 5
“Exercise also helps in weight loss and improves aerobic capacity consequently reducing the symptoms of OSA (American Association of Cardiovascular and Pulmonary Rehabilitation, 2010; Gottlieb and Punjabi, 2020).”
Background
Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea in Spain: Implementation Strategy and Early Results in a Tertiary Care Center
Baptista, P., Prieto-Matos, C., Alegre, M., Urrestarazu-Bolumburu, E., & Navarrete, J. A. (2021) · Indian Journal of Otolaryngology and Head & Neck Surgery · doi:10.1007/s12070-021-02503-1 · Cited by 5
Health-related quality of life in obstructive sleep apnea
Jobanputra, A. M., & Aurora, R. N. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-822963-7.00333-9 · Cited by 5
Effects of mindfulness meditation and Acceptance and commitment therapy in patients with obstructive sleep apnea with residual excessive sleepiness: A randomized controlled pilot study
Hellrigel-Holderbaum, M., Romanczuk-Seiferth, N., Glos, M., & Fietze, I. (2023) · Sleep Medicine · doi:10.1016/j.sleep.2023.03.022 · Cited by 5
Identifying an acceptable number of ambulatory blood pressure measurements for accuracy of average blood pressure and nocturnal dipping status
Brito, L. C., Rice, S. P. M., Bowles, N. P., Butler, M. P., McHill, A. W., Emens, J. S., Shea, S. A., & Thosar, S. S. (2024) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00220.2024 · Cited by 4
Obstructive Sleep Apnea: Prevalence, Risk Factors, and Impact on the Academic Performance of Medical Students at a Saudi Arabian University
Alharbi, S. M., Alanazi, A. A., Alamri, A. S., Alaluan, H. F., Alhuways, W. A., Suwayid, R. K., & Almeneessier, A. S. (2025) · Saudi Journal of Medicine and Medical Sciences · doi:10.4103/sjmms.sjmms_5_24 · Cited by 4
Independent Association of Sleep Apnea-Specific Hypoxic Burden and Sleep Breathing Impairment Index with Thyroid Function in Obstructive Sleep Apnea: A Retrospective Study
Zhou, Y., Shi, Y., Zhu, S., Cao, Z., Xie, Y., Lu, C., Niu, X., Ma, L., Wang, Z., Su, Y., et al. (2025) · Nature and Science of Sleep · doi:10.2147/nss.s525750 · Cited by 4
Failure to complete diagnostic testing in patients with suspected obstructive sleep apnoea and inconclusive home sleep apnoea test
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Navigating the assessment of sleep-related bruxism: Clinical guidance for applying the 2023 ICSD-3-TR criteria
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Maxilla First versus Mandible First in 2-Jaw Orthognathic Surgery: Determining Factors and Outcomes
Fukui, M., Yao, C.-F., Mam, S., & Lo, L. (2025) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000012608 · Cited by 4
The Role of Obstructive Sleep Apnea and CPAP Therapy in the Functional Hypogonadism of Male Patients With Severe Obesity
Amodeo, A., Cangiano, B., Duca, N. D., Chilà, A., Musolino, A., Garavaglia, I., Donne, E. D., Casiraghi, A., Manzini, C., Vezzoli, V., et al. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf635 · Cited by 4
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Influential
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“54 Notably, it does not incorporate other crucial patient characteristics such as high blood pressure, BMI, age, neck circumference, and gender, which could enhance diagnostic accuracy.”

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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