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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Background
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Background
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Subramaniam, M., Mohan, K. R., Fenn, S. M., & Thangavelu, R. P. (2023) · Cureus · doi:10.7759/cureus.38644 · Cited by 2
“Surgical and non-surgical treatment modalities for obstructive sleep apnea The various surgical and non-surgical modalities for obstructive sleep apnea [4-13] (Table 5).”
Background
Relationship Between Hyperuricemia-Waist Phenotype and Obstructive Sleep Apnea in Type 2 Diabetes Mellitus
Lu, N., & Yin, F. (2023) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s408637 · Cited by 3
CPAP therapy for obstructive sleep apnoea: are the right questions being asked?
Gottlieb, D. J. (2023) · European Respiratory Journal · doi:10.1183/13993003.00575-2023 · Cited by 2
Self-citation
Hearing loss and history of otolaryngological conditions in adults with microdeletion 22q11.2
von Scheibler, E. N. M. M., Widdershoven, J. C. C., Barneveld, D. C. P. B. M. V., Schröder, N., van Eeghen, A. M., van Amelsvoort, T., & Boot, E. (2023) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.63456 · Cited by 2
“OSA can have a negative effect on quality of life, and may increase the risk of several diseases including cardiovascular and pulmonary systems (Gottlieb & Punjabi, 2020).”
Background
Patient-Reported Outcomes of Maxillomandibular Surgery for Obstructive Sleep Apnea Treatment: A Scoping Review
Francisco, I., Nunes, C., Paula, A. B., Marques, F., Ribeiro, M. P., McEvoy, M., Santos, M., Oliveira, C. R., Marto, C. M., Spagnuolo, G., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13051232 · Cited by 2
Monitoring of Home Respiratory Polygraphy During Mandibular Distraction Osteogenesis Succeeded by LeFort I Osteotomy in Adult Patients With Obstructive Sleep Apnea
Martín, G. H., Rubio-Bueno, P., Moreno, A. C., Arjona, B. A., Durán‐Cantolla, J., & Wyx, R. (2024) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2024.04.002 · Cited by 2
Tele-Pulmonary Rehabilitation and Mediterranean-like Lifestyle, Adjunctively to Continuous Positive Airway Pressure in Obstructive Sleep Apnea Patients: Effects in Fitness and Oxidative Indicators
Stavrou, V. T., Papayianni, E., Astara, K., Vavougios, G. D., Kontogianni, M. D., Bargiota, Α., Pastaka, C., Daniil, Z. D., & Gourgoulianis, K. I. (2024) · Applied Sciences · doi:10.3390/app14188424 · Cited by 2
Continuous positive airway pressure adherence and blood pressure lowering in patients with obstructive sleep apnoea syndrome and nocturnal hypertension
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Electronic health record–derived outcomes in obstructive sleep apnea managed with positive airway pressure tracking systems
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“2,25 Large, longitudinal databases enabled by electronic health records (EHRs) have the potential to verify that treatments are effective when applied across heterogeneous populations in practice.”
Racial Differences in Functional and Sleep Outcomes with Positive Airway Pressure Treatment
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“Obstructive sleep apnea (OSA) is characterized by episodes of repetitive obstruction of the upper airway [1] that are associated with oxyhemoglobin desaturations, sympathetic over-activation, inflammation and arousals [2].”
Background
Effect of Mandibular Advancement through Oral Appliance Therapy on Quality of Life in Obstructive Sleep Apnea: A Scoping Review
Sharma, P., Raghav, P., Kalonia, N., & Amit, K. (2022) · Indian Journal of Sleep Medicine · doi:10.5005/jp-journals-10069-0088 · Cited by 2
Impact of obstructive sleep apnea on health-related quality of life in patients with partial laryngectomy for laryngeal cancerPreprint
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miR-roring Changes in Blood: miR-210 Reflects Hypoxic Disease Dynamics in Obstructive Sleep Apnea
Kirillova, A., & Chan, S. Y. (2022) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202209-1709ed · Cited by 2
“This has timely relevance, given the currently limited treatment options for OSA and variable response to those therapies (13).”
Background
Functional connectivity changes in the insular subregions of patients with obstructive sleep apnea after 6 months of continuous positive airway pressure treatment: a resting-state functional magnetic resonance imaging study.Preprint
Long, T., Li, H., Shu, Y., Li, K., Xie, W., Zeng, Y., Huang, L., Zeng, L., Liu, X., & Peng, D. (2022) · Research Square · doi:10.21203/rs.3.rs-2220078/v1 · Cited by 2
Characterization of genetic neurodevelopmental disorders at adult age, with a focus on 22q11.2 deletion syndrome
von Scheibler, E. N. M. M. (2023) · Research Publications (Maastricht University) · doi:10.26481/dis.20231114eb · Cited by 2
Most Custom Oral Appliances for Obstructive Sleep Apnea Do Not Meet the Definition of CustomPreprint
Liptak, L. A., Remmers, J. E., Mosca, E., Kim, S., Sall, E., & Charkhandeh, S. (2025) · Preprints.org · doi:10.20944/preprints202505.1121.v1 · Cited by 2
IMPACT OF OBSTRUCTIVE SLEEP APNEA-HYPOPNEA SYNDROME SEVERITY ON HEART RATE VARIABILITY AND QTC INTERVAL IN HYPERTENSIVE PATIENTS
Stojanović, M., Ilic, M. D., Ristić, L., Stamenković, Z., Koracevic, G. P., Gojkovic, D., & Kostic, J. (2025) · Journal of Hypertension · doi:10.1097/01.hjh.0001196676.57601.48 · Cited by 2
Possible genetic cross-talk between Down syndrome and obstructive sleep apnea revealed by transcriptomic analysis
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“OSA is characterized by intermittent hypoxia, non-restorative sleep, and hypercapnia, which may cause multiple complications such as metabolic syndrome, cardiovascular disease, and cognitive impairment [5].”
Background
Impact of Obstructive Sleep Apnea on Health-Related Quality of Life in Patients With Partial Laryngectomy for Laryngeal Cancer
Chen, M., Shi, F., Wu, H., Cheng, L., He, P., Jin, Q., & Huang, J. (2023) · Ear Nose & Throat Journal · doi:10.1177/01455613231178955 · Cited by 1
Performance of the Activities and Participation component of International Classification of Functioning, Disability and Health Sleep Disorders Brief Core Set in patients with obstructive sleep apnea
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“Polysomnography (PSG) is currently the gold standard for the diagnosis of OSA, which focuses on monitoring the nocturnal apnea-hypopnea index (AHI) and oxygen desaturation index (7).”
Evaluation of clinical and genetic factors in obstructive sleep apnoea
Guimarães, M. D. L. R., de Azevedo, P. G., de Souza, R. P., Gomes‐Fernandes, B., Friedman, E., Marco, L. A. D., & Bastos‐Rodrigues, L. (2023) · Acta Otorhinolaryngologica Italica · doi:10.14639/0392-100x-n2532 · Cited by 1
Interventional management of mitral regurgitation and sleep disordered breathing: “Catching two birds with one stone”
Dimitriadis, K. S., Stathakopoulou, C., Pyrpyris, N., Beneki, E., Adamopoulou, E., Σουλαϊδόπουλος, Σ., Leontsinis, I., Kasiakogias, A., Papanikolaou, A., Tsioufis, P., et al. (2023) · Sleep Medicine · doi:10.1016/j.sleep.2023.11.019 · Cited by 1
Obstructive Sleep Apnea: Strategies for Screening, Management, and Overcoming Treatment Challenges in the Outpatient Setting
Shah, R. M., Sethi, J. M., Wolf, L., LaCavera, M., & Koo, P. (2023) · American Journal of Lifestyle Medicine · doi:10.1177/15598276231217949 · Cited by 1
“18 MMA is a highly invasive procedure but comes with a reduction in AHI in up to 98% of patients, with the most impact seen in OSA patients with a preoperative AHI of 60 events/ hour.”
Introduction
Baptista, P., & Mayor, G. P. (2023) · Springer eBooks · doi:10.1007/978-3-031-35225-6_1 · Cited by 1
Efficacy of Mandibular Advancement Splint to Manage Obstructive Sleep Apnea Patients: A Systematic Review
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Exploring the impact of OSA on short-term survival in patients with AECOPD admitted to the ICU
Liu, L., Chen, Y., He, G., Lin, B., Zhu, Z., Wei, R., & Xu, Y. (2024) · PLoS ONE · doi:10.1371/journal.pone.0301646 · Cited by 1
“In the US, the occurrence of OSA is higher among men than women with 34% of males and 17% of females affected [13].”
Background
Digital sleep clinic: assessing efficacy of continuous positive airway pressure through sleep staging via connected devices: a study protocol
Messaoud, R. B., Baillieul, S., Tamisier, R., Terrail, R., Bailly, S., Joyeux‐Faure, M., & Pépin, J. (2024) · BMC Digital Health · doi:10.1186/s44247-024-00077-w · Cited by 1
“Symptoms associated with OSA include snoring, daytime sleepiness, fatigue, morning headaches [2] and deterioration in quality of life [3].”
Background
Linking orthodontic treatment and sleep apnea among adult Indian patients
Kumar, A., Gupta, A. K., Kaur, S., Singh, V. K., Panika, A., & Singh, S. (2024) · Bioinformation · doi:10.6026/973206300200349 · Cited by 1
Obstructive sleep apnea as a potentially reversible cause of nighttime bradyarrhythmias. Clinical case
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The impact of obesity, age, and gender on plasmatic levels of selected glycoprotein biomarkers and miRNA-499 in OSA patients
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“Its primary goal is to improve patients’ quality of life, personally and professionally (Jennum et al., 2014), by managing their basic disease and comorbidities (Pinto et al., 2016; Gottlieb and Punjabi, 2020).”
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Zhu, M. Q., Cnattingius, S., O’Brien, L. M., & Villamor, E. (2024) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.11228 · Cited by 1
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Towards an Accessible Speech-based Obstructive Sleep Apnea Screening Tool for Underserved Populations
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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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