Sleep apnea: Difference between revisions

Latest revision as of 21:12, 5 November 2025

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Sleep apnea (sleep apnoea or sleep apnœa in British English) is a sleep-related breathing disorder in which repetitive pauses in breathing, periods of shallow breathing, or collapse of the upper airway during sleep results in poor ventilation and sleep disruption.^[1]^[2] Each pause in breathing can last for a few seconds to a few minutes and often occurs many times a night.^[3] A choking or snorting sound may occur as breathing resumes.^[3] Common symptoms include daytime sleepiness, snoring, and non-restorative sleep despite adequate sleep time.^[4] Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day.^[3] It is often a chronic condition.^[5]

Sleep apnea may be categorized as obstructive sleep apnea (OSA), in which breathing is interrupted by a blockage of air flow, central sleep apnea (CSA), in which regular unconscious breath simply stops, or a combination of the two.^[3] OSA is the most common form.^[3] OSA has four key contributors; these include a narrow, crowded, or collapsible upper airway, an ineffective pharyngeal dilator muscle function during sleep, airway narrowing during sleep, and unstable control of breathing (high loop gain).^[6]^[7] In CSA, the basic neurological controls for breathing rate malfunction and fail to give the signal to inhale, causing the individual to miss one or more cycles of breathing. If the pause in breathing is long enough, the percentage of oxygen in the circulation can drop to a lower than normal level (hypoxemia) and the concentration of carbon dioxide can build to a higher than normal level (hypercapnia).^[8] In turn, these conditions of hypoxia and hypercapnia will trigger additional effects on the body such as Cheyne-Stokes Respiration.^[9]

Some people with sleep apnea are unaware they have the condition.^[3] In many cases it is first observed by a family member.^[3] An in-lab sleep study overnight is the preferred method for diagnosing sleep apnea.^[7] In the case of OSA, the outcome that determines disease severity and guides the treatment plan is the apnea-hypopnea index (AHI).^[7] This measurement is calculated from totaling all pauses in breathing and periods of shallow breathing lasting greater than 10 seconds and dividing the sum by total hours of recorded sleep.^[1]^[7] In contrast, for CSA the degree of respiratory effort, measured by esophageal pressure or displacement of the thoracic or abdominal cavity, is an important distinguishing factor between OSA and CSA.^[10]

A systemic disorder, sleep apnea is associated with a wide array of effects, including increased risk of car accidents, hypertension, cardiovascular disease, myocardial infarction, stroke, atrial fibrillation, insulin resistance, higher incidence of cancer, and neurodegeneration.^[11] Further research is being conducted on the potential of using biomarkers to understand which chronic diseases are associated with sleep apnea on an individual basis.^[11]

Treatment may include lifestyle changes, mouthpieces, breathing devices, and surgery.^[3] Effective lifestyle changes may include avoiding alcohol, losing weight, smoking cessation, and sleeping on one's side.^[12] Breathing devices include the use of a CPAP machine.^[13] With proper use, CPAP improves outcomes.^[14] Evidence suggests that CPAP may improve sensitivity to insulin, blood pressure, and sleepiness.^[15]^[16]^[17] Long term compliance, however, is an issue with more than half of people not appropriately using the device.^[14]^[18] In 2017, only 15% of potential patients in developed countries used CPAP machines, while in developing countries well under 1% of potential patients used CPAP.^[19]Template:Unreliable source Without treatment, sleep apnea may increase the risk of heart attack, stroke, diabetes, heart failure, irregular heartbeat, obesity, and motor vehicle collisions.^[3]

OSA is a common sleep disorder. A large analysis in 2019 of the estimated prevalence of OSA found that OSA affects 936 million—1 billion people between the ages of 30–69 globally, or roughly every 1 in 10 people, and up to 30% of the elderly.^[20] Sleep apnea is somewhat more common in men than women, roughly a 2:1 ratio of men to women, and in general more people are likely to have it with older age and obesity. Other risk factors include being overweight,^[11] a family history of the condition, allergies, and enlarged tonsils.^[21]

Signs and symptoms

The typical screening process for sleep apnea involves asking patients about common symptoms such as snoring, witnessed pauses in breathing during sleep and excessive daytime sleepiness.^[11] There is a wide range in presenting symptoms in patients with sleep apnea, from being asymptomatic to falling asleep while driving.^[11] Due to this wide range in clinical presentation, some people are not aware that they have sleep apnea and are either misdiagnosed or ignore the symptoms altogether.^[22] A current area requiring further study involves identifying different subtypes of sleep apnea based on patients who tend to present with different clusters or groupings of particular symptoms.^[11]

OSA may increase risk for driving accidents and work-related accidents due to sleep fragmentation from repeated arousals during sleep.^[11] If OSA is not treated it results in excessive daytime sleepiness and oxidative stress from the repeated drops in oxygen saturation, people are at increased risk of other systemic health problems, such as diabetes, hypertension or cardiovascular disease.^[11] Subtle manifestations of sleep apnea may include treatment refractory hypertension and cardiac arrhythmias and over time as the disease progresses, more obvious symptoms may become apparent.^[4] Due to the disruption in daytime cognitive state, behavioral effects may be present. These can include moodiness, belligerence, as well as a decrease in attentiveness and energy.^[23] These effects may become intractable, leading to depression.^[24]

Risk factors

Obstructive sleep apnea can affect people regardless of sex, race, or age.^[25] However, risk factors include:^[26]

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male sex^[26]^[27]^[10]
obesity^[26]^[27]
age over 40^[26]
large neck circumference^[26]
enlarged tonsils or tongue^[26]
narrow upper jaw^[7]
small lower jaw^[27]
tongue fat/tongue scalloping^[7]
a family history of sleep apnea^[26]
endocrine disorders^[26] such as hypothyroidism^[27]
lifestyle habits such as smoking or drinking alcohol^[26]

Template:Colend Central sleep apnea is more often associated with any of the following risk factors:^[10]

transition period from wakefulness to non-REM sleep^[10]
older age^[10]
heart failure^[10]
atrial fibrillation^[10]
stroke^[10]
spinal cord injury^[10]

Mechanism

Obstructive sleep apnea

The causes of obstructive sleep apnea are complex and individualized, but typical risk factors include narrow pharyngeal anatomy and craniofacial structure.^[7] When anatomical risk factors are combined with non-anatomical contributors such as an ineffective pharyngeal dilator muscle function during sleep, unstable control of breathing (high loop gain), and premature awakening to mild airway narrowing, the severity of the OSA rapidly increases as more factors are present.^[7] When breathing is paused due to upper airway obstruction, carbon dioxide builds up in the bloodstream. Chemoreceptors in the bloodstream note the high carbon dioxide levels. The brain is signaled to awaken the person, which clears the airway and allows breathing to resume. Breathing normally will restore oxygen levels and the person will fall asleep again.^[28] This carbon dioxide build-up may be due to the decrease of output of the brainstem regulating the chest wall or pharyngeal muscles, which causes the pharynx to collapse.^[29] As a result, people with sleep apnea experience reduced or no slow-wave sleep and spend less time in REM sleep.^[29]

Central sleep apnea

There are two main mechanism that drive the disease process of CSA, sleep-related hypoventilation and post-hyperventilation hypocapnia.^[10] The most common cause of CSA is post-hyperventilation hypocapnia secondary to heart failure.^[10] This occurs because of brief failures of the ventilatory control system but normal alveolar ventilation.^[10] In contrast, sleep-related hypoventilation occurs when there is a malfunction of the brain's drive to breathe.^[10] The underlying cause of the loss of the wakefulness drive to breathe encompasses a broad set of diseases from strokes to severe kyphoscoliosis.^[10]

Complications

OSA is a serious medical condition with systemic effects; patients with untreated OSA have a greater mortality risk from cardiovascular disease than those undergoing appropriate treatment.^[30] Other complications include hypertension, congestive heart failure, atrial fibrillation, coronary artery disease, stroke, and type 2 diabetes.^[30] Daytime fatigue and sleepiness, a common symptom of sleep apnea, is also an important public health concern regarding transportation crashes caused by drowsiness.^[30] OSA may also be a risk factor of COVID-19. People with OSA have a higher risk of developing severe complications of COVID-19.^[31]

Alzheimer's disease and severe obstructive sleep apnea are connected^[32] because there is an increase in the protein beta-amyloid as well as white-matter damage. These are the main indicators of Alzheimer's, which in this case comes from the lack of proper rest or poorer sleep efficiency resulting in neurodegeneration.^[33]^[34]^[35] Having sleep apnea in mid-life brings a higher likelihood of developing Alzheimer's in older age, and if one has Alzheimer's then one is also more likely to have sleep apnea.^[36] This is demonstrated by cases of sleep apnea even being misdiagnosed as dementia.^[37] With the use of treatment through CPAP, there is a reversible risk factor in terms of the amyloid proteins. This usually restores brain structure and cognitive impairment.^[38]^[39]^[40] Evidence continues to be found supporting there is an association between BMI and Alzheimer's.^[41] There is also evidence of increased risk of developing Alzheimer's for those with a higher BMI in women ages 70 and above.^[42] While continuous positive airway pressure (CPAP) wasn't found to significantly improve cognitive performance, it was found to benefit other symptoms like depression, anxiety, etc.^[43]

Diagnosis

Classification

There are three types of sleep apnea. OSA accounts for 84%, CSA for 0.9%, and 15% of cases are mixed.^[44]

Obstructive sleep apnea

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File:ObstructiveApnea.png

Screenshot of a PSG system showing an obstructive apnea

File:New no obstruction.png

No airway obstruction during sleep

File:Airway obstruction.png

Airway obstruction during sleep

In a systematic review of published evidence, the United States Preventive Services Task Force in 2017 concluded that there was uncertainty about the accuracy or clinical utility of all potential screening tools for OSA,^[45] and recommended that evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults.^[46]

The diagnosis of OSA syndrome is made when the patient shows recurrent episodes of partial or complete collapse of the upper airway during sleep resulting in apneas or hypopneas, respectively.^[47] Criteria defining an apnea or a hypopnea vary. The American Academy of Sleep Medicine (AASM) defines an apnea as a reduction in airflow of ≥ 90% lasting at least 10 seconds. A hypopnea is defined as a reduction in airflow of ≥ 30% lasting at least 10 seconds and associated with a ≥ 4% decrease in pulse oxygenation, or as a ≥ 30% reduction in airflow lasting at least 10 seconds and associated either with a ≥ 3% decrease in pulse oxygenation or with an arousal.^[48]

To define the severity of the condition, the Apnea-Hypopnea Index (AHI) or the Respiratory Disturbance Index (RDI) are used. While the AHI measures the mean number of apneas and hypopneas per hour of sleep, the RDI adds to this measure the respiratory effort-related arousals (RERAs).^[49] The OSA syndrome is thus diagnosed if the AHI is > 5 episodes per hour and results in daytime sleepiness and fatigue or when the RDI is ≥ 15 independently of the symptoms.^[50] According to the American Association of Sleep Medicine, daytime sleepiness is determined as mild, moderate and severe depending on its impact on social life. Daytime sleepiness can be assessed with the Epworth Sleepiness Scale (ESS), a self-reported questionnaire on the propensity to fall asleep or doze off during daytime.^[51] Screening tools for OSA comprise the STOP questionnaire, the Berlin questionnaire and the STOP-BANG questionnaire which has been reported as being a powerful tool to detect OSA.^[52]^[53]

Criteria

According to the International Classification of Sleep Disorders, there are 4 types of criteria.^[54]^[55] The first one concerns sleep – excessive sleepiness, non-restorative sleep, fatigue or insomnia symptoms. The second and third criteria are about respiration – waking with breath holding, gasping, or choking; snoring, breathing interruptions or both during sleep. The last criterion revolved around medical issues as hypertension, coronary artery disease, stroke, heart failure, atrial fibrillation, type 2 diabetes mellitus, mood disorder or cognitive impairment. Two levels of severity are distinguished, the first one is determined by a polysomnography or home sleep apnea test demonstrating 5 or more predominantly obstructive respiratory events per hour of sleep and the higher levels are determined by 15 or more events. If the events are present less than 5 times per hour, no obstructive sleep apnea is diagnosed.^[55]

A considerable night-to-night variability further complicates diagnosis of OSA. In unclear cases, multiple nights of testing might be required to achieve an accurate diagnosis.^[56] Since sequential nights of testing would be impractical and cost prohibitive in the sleep lab, home sleep testing for multiple nights can not only be more useful, but more reflective of what is typically happening each night.^[57]

Polysomnography

AHI	Rating
< 5	Normal
5–15	Mild
15–30	Moderate
> 30	Severe

Nighttime in-laboratory Level 1 polysomnography (PSG) is the gold standard test for diagnosis. Patients are monitored with EEG leads, pulse oximetry, temperature and pressure sensors to detect nasal and oral airflow, respiratory impedance plethysmography or similar resistance belts around the chest and abdomen to detect motion, an ECG lead, and EMG sensors to detect muscle contraction in the chin, chest, and legs. A hypopnea can be based on one of two criteria. It can either be a reduction in airflow of at least 30% for more than 10 seconds associated with at least 4% oxygen desaturation or a reduction in airflow of at least 30% for more than 10 seconds associated with at least 3% oxygen desaturation or an arousal from sleep on EEG.^[58]

An "event" can be either an apnea, characterized by complete cessation of airflow for at least 10 seconds, or a hypopnea in which airflow decreases by 50 percent for 10 seconds or decreases by 30 percent if there is an associated decrease in the oxygen saturation or an arousal from sleep.^[59] To grade the severity of sleep apnea, the number of events per hour is reported as the apnea-hypopnea index (AHI). An AHI of less than 5 is considered normal. An AHI of 5–15 is mild; 15–30 is moderate, and more than 30 events per hour characterizes severe sleep apnea.

Central sleep apnea

Script error: No such module "Labelled list hatnote". The diagnosis of CSA syndrome is made when the presence of at least 5 central apnea events occur per hour.^[2] There are multiple mechanisms that drive the apnea events. In individuals with heart failure with Cheyne-Stokes respiration, the brain's respiratory control centers are imbalanced during sleep.^[60] This results in ventilatory instability, caused by chemoreceptors that are hyperresponsive to CO₂ fluctuations in the blood, resulting in high respiratory drive that leads to apnea.^[2] Another common mechanism that causes CSA is the loss of the brain's wakefulness drive to breathe.^[2]

File:CentralApnea.png

Screenshot of a PSG system showing a central apnea

CSA is organized into 6 individual syndromes: Cheyne-Stokes respiration, Complex sleep apnea, Primary CSA, High altitude periodic breathing, CSA from medication, CSA from comorbidity.^[2] Like in OSA, nocturnal polysomnography is the mainstay of diagnosis for CSA.^[10] The degree of respiratory effort, measured by esophageal pressure or displacement of the thoracic or abdominal cavity, is an important distinguishing factor between OSA and CSA.^[10]

Mixed apnea

Some people with sleep apnea have a combination of both types; its prevalence ranges from 0.56% to 18%. The condition, also called treatment-emergent central apnea, is generally detected when obstructive sleep apnea is treated with CPAP and central sleep apnea emerges.^[10] The exact mechanism of the loss of central respiratory drive during sleep in OSA is unknown but is most likely related to incorrect settings of the CPAP treatment and other medical conditions the person has.^[61]

Management

The treatment of obstructive sleep apnea is different than that of central sleep apnea. Treatment often starts with behavioral therapy and some people may be suggested to try a continuous positive airway pressure (CPAP) device. Many people are told to avoid alcohol, sleeping pills, and other sedatives, which can relax throat muscles, contributing to the collapse of the airway at night.^[62] The evidence supporting one treatment option compared to another for a particular person is not clear.^[63]

Changing sleep position

More than half of people with obstructive sleep apnea have some degree of positional obstructive sleep apnea, meaning that it gets worse when they sleep on their backs.^[64] Sleeping on their sides is an effective and cost-effective treatment for positional obstructive sleep apnea.^[64]

Continuous positive airway pressure

File:Cpapanwender.jpg

Person using a CPAP mask, covering only the nose

File:CPAP device on a nightstand.jpg

CPAP device on a nightstand

Script error: No such module "Labelled list hatnote". For moderate to severe sleep apnea, the most common treatment is the use of a continuous positive airway pressure (CPAP) or automatic positive airway pressure (APAP) device.^[62]^[65] These splint the person's airway open during sleep by means of pressurized air. The person typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine.^[62]

Although CPAP therapy is effective in reducing apneas and less expensive than other treatments, some people find it uncomfortable. Some complain of feeling trapped, having chest discomfort, and skin or nose irritation. Other side effects may include dry mouth, dry nose, nosebleeds, sore lips and gums.^[66]

Whether or not it decreases the risk of death or heart disease is controversial with some reviews finding benefit and others not.^[14]^[67]^[63] This variation across studies might be driven by low rates of compliance—analyses of those who use CPAP for at least four hours a night suggests a decrease in cardiovascular events.^[68]

Weight loss

Excess body weight is thought to be an important cause of sleep apnea.^[69] People who are overweight have more tissues in the back of their throat which can restrict the airway, especially when sleeping.^[70] In weight loss studies of overweight individuals, those who lose weight show reduced apnea frequencies and improved apnoea–hypopnoea index (AHI).^[69]^[71] Weight loss effective enough to relieve obesity hypoventilation syndrome (OHS) must be 25–30% of body weight. For some obese people, it can be difficult to achieve and maintain this result without bariatric surgery.^[72]

Rapid palatal expansion

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In children, orthodontic treatment to expand the volume of the nasal airway, such as nonsurgical rapid palatal expansion is common. The procedure has been found to significantly decrease the AHI and lead to long-term resolution of clinical symptoms.^[73]^[74]

Since the palatal suture is fused in adults, regular RPE using tooth-borne expanders cannot be performed. Mini-implant assisted rapid palatal expansion (MARPE) has been recently developed as a non-surgical option for the transverse expansion of the maxilla in adults. This method increases the volume of the nasal cavity and nasopharynx, leading to increased airflow and reduced respiratory arousals during sleep.^[75]^[76] Changes are permanent with minimal complications.

Surgery

File:Cautérisation des parties molles - apnée du sommeil.svg

Illustration of surgery on the mouth and throat

Several surgical procedures (sleep surgery) are used to treat sleep apnea, although they are normally a third line of treatment for those who reject or are not helped by CPAP treatment or dental appliances.^[14] Surgical treatment for obstructive sleep apnea needs to be individualized to address all anatomical areas of obstruction.^[1]

Nasal obstruction

Often, correction of the nasal passages needs to be performed in addition to correction of the oropharynx passage. Septoplasty and turbinate surgery may improve the nasal airway,^[77] but has been found to be ineffective at reducing respiratory arousals during sleep.^[78]

Pharyngeal obstruction

Tonsillectomy and uvulopalatopharyngoplasty (UPPP or UP3) are available to address pharyngeal obstruction.^[1]

File:UPPP. 4 figures..png

Uvulopalatopharyngoplasty. A) pre-operative, B) original UPPP, C) modified UPPP, and D) minimal UPPP.

The "Pillar" device is a treatment for snoring and obstructive sleep apnea; it is thin, narrow strips of polyester. Three strips are inserted into the roof of the mouth (the soft palate) using a modified syringe and local anesthetic, in order to stiffen the soft palate. This procedure addresses one of the most common causes of snoring and sleep apnea — vibration or collapse of the soft palate. It was approved by the FDA for snoring in 2002 and for obstructive sleep apnea in 2004. A 2013 meta-analysis found that "the Pillar implant has a moderate effect on snoring and mild-to-moderate obstructive sleep apnea" and that more studies with high level of evidence were needed to arrive at a definite conclusion; it also found that the polyester strips work their way out of the soft palate in about 10% of the people in whom they are implanted.^[79]

Hypopharyngeal or base of tongue obstruction

Base-of-tongue advancement by means of advancing the genial tubercle of the mandible, tongue suspension, or hyoid suspension (aka hyoid myotomy and suspension or hyoid advancement) may help with the lower pharynx.^[1]

Other surgery options may attempt to shrink or stiffen excess tissue in the mouth or throat, procedures done at either a doctor's office or a hospital. Small shots or other treatments, sometimes in a series, are used for shrinkage, while the insertion of a small piece of stiff plastic is used in the case of surgery whose goal is to stiffen tissues.^[62]

Multi-level surgery

Maxillomandibular advancement is considered the most effective surgery for people with sleep apnea, because it increases the posterior airway space.^[80] However, health professionals are often unsure as to who should be referred for surgery and when to do so: some factors in referral may include failed use of CPAP or device use; anatomy which favors rather than impedes surgery; or significant craniofacial abnormalities which hinder device use.^[81]

Potential complications

Several inpatient and outpatient procedures use sedation. Many drugs and agents used during surgery to relieve pain and to depress consciousness remain in the body at low amounts for hours or even days afterwards. In an individual with either central, obstructive or mixed sleep apnea, these low doses may be enough to cause life-threatening irregularities in breathing or collapses in a patient's airways.^[82] Use of analgesics and sedatives in these patients postoperatively should therefore be minimized or avoided.^[1]

Surgery on the mouth and throat, as well as dental surgery and procedures, can result in postoperative swelling of the lining of the mouth and other areas that affect the airway. Even when the surgical procedure is designed to improve the airway, such as tonsillectomy and adenoidectomy or tongue reduction, swelling may negate some of the effects in the immediate postoperative period. Once the swelling resolves and the palate becomes tightened by postoperative scarring, however, the full benefit of the surgery may be noticed.^[1]

A person with sleep apnea undergoing any medical treatment must make sure their doctor and anesthetist are informed about the sleep apnea. Alternative and emergency procedures may be necessary to maintain the airway of sleep apnea patients.^[83]

Other

Neurostimulation

Diaphragm pacing, which involves the rhythmic application of electrical impulses to the diaphragm, has been used to treat central sleep apnea.^[84]^[85]

In April 2014, the U.S. Food and Drug Administration granted pre-market approval for use of an upper airway stimulation system in people who cannot use a continuous positive airway pressure device. The Inspire Upper Airway Stimulation system is a hypoglossal nerve stimulation implant that senses respiration and applies mild electrical stimulation during inspiration, which pushes the tongue slightly forward to open the airway.^[86]

Medications

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There is currently insufficient evidence to recommend any medication for OSA.^[87] This may result in part because people with sleep apnea have tended to be treated as a single group in clinical trials. Identifying specific physiological factors underlying sleep apnea makes it possible to test drugs specific to those causal factors: airway narrowing, impaired muscle activity, low arousal threshold for waking, and unstable breathing control.^[88]^[89] Those who experience low waking thresholds may benefit from eszopiclone, a sedative typically used to treat insomnia.^[88]^[90] The antidepressant desipramine may stimulate upper airway muscles and lessen pharyngeal collapsibility in people who have limited muscle function in their airways.^[88]^[91]

There is limited evidence for medication, but 2012 AASM guidelines suggested that acetazolamide "may be considered" for the treatment of central sleep apnea; zolpidem and triazolam may also be considered for the treatment of central sleep apnea,^[92] but "only if the patient does not have underlying risk factors for respiratory depression".^[87]^[65] Low doses of oxygen are also used as a treatment for hypoxia but are discouraged due to side effects.^[93]^[94]^[95]

In December 2024, the FDA approved tirzepatide, an anti-diabetic and weight loss medication, as a component in the combination treatment of adults with obesity suffering from moderate to severe obstructive sleep apnea. Other components of the therapy are a reduced-calorie diet and increased physical activity.^[96]

Oral appliances

An oral appliance, often referred to as a mandibular advancement splint, is a custom-made mouthpiece that shifts the lower jaw forward and opens the bite slightly, opening up the airway. These devices can be fabricated by a general dentist. Oral appliance therapy is usually successful in patients with mild to moderate obstructive sleep apnea.^[97]^[98] While CPAP is more effective for sleep apnea than oral appliances, oral appliances improve sleepiness and quality of life and are often better tolerated than CPAP.^[98]

Nasal EPAP

Nasal EPAP is a bandage-like device placed over the nostrils that uses a person's own breathing to create positive airway pressure to prevent obstructed breathing.^[99]

Oral pressure therapy

Oral pressure therapy uses a device that creates a vacuum in the mouth, pulling the soft palate tissue forward. It has been found useful in about 25% to 37% of people.^[100]^[101]

Prognosis

Death could occur from untreated OSA due to lack of oxygen to the body.^[66]

There is increasing evidence that sleep apnea may lead to liver function impairment, particularly fatty liver diseases (see steatosis).^[102]^[103]^[104]^[105]

It has been revealed that people with OSA show tissue loss in brain regions that help store memory, thus linking OSA with memory loss.^[106] Using magnetic resonance imaging (MRI), the scientists discovered that people with sleep apnea have mammillary bodies that are about 20% smaller, particularly on the left side. One of the key investigators hypothesized that repeated drops in oxygen lead to the brain injury.^[107]

The immediate effects of central sleep apnea on the body depend on how long the failure to breathe endures. At worst, central sleep apnea may cause sudden death. Short of death, drops in blood oxygen may trigger seizures, even in the absence of epilepsy. In people with epilepsy, the hypoxia caused by apnea may trigger seizures that had previously been well controlled by medications.^[108] In other words, a seizure disorder may become unstable in the presence of sleep apnea. In adults with coronary artery disease, a severe drop in blood oxygen level can cause angina, arrhythmias, or heart attacks (myocardial infarction). Longstanding recurrent episodes of apnea, over months and years, may cause an increase in carbon dioxide levels that can change the pH of the blood enough to cause a respiratory acidosis.Template:Medical citation needed

Epidemiology

Script error: No such module "Unsubst". The Wisconsin Sleep Cohort Study estimated in 1993 that roughly one in every 15 Americans was affected by at least moderate sleep apnea.^[109]^[110] It also estimated that in middle-age as many as 9% of women and 24% of men were affected, undiagnosed and untreated.^[69]^[109]^[110]

The costs of untreated sleep apnea reach further than just health issues. It is estimated that in the U.S., the average untreated sleep apnea patient's annual health care costs $1,336 more than an individual without sleep apnea. This may cause $3.4 billion/year in additional medical costs. Whether medical cost savings occur with treatment of sleep apnea remains to be determined.^[111]

Frequency and population

Sleep disorders including sleep apnea have become an important health issue in the United States. Twenty-two million Americans have been estimated to have sleep apnea, with 80% of moderate and severe OSA cases undiagnosed.^[112]

OSA can occur at any age, but it happens more frequently in men who are over 40 and overweight.^[112]

History

A type of CSA was described in the German myth of Ondine's curse where the person when asleep would forget to breathe.^[113] The clinical picture of this condition has long been recognized as a character trait, without an understanding of the disease process. The term "Pickwickian syndrome" that is sometimes used for the syndrome was coined by the famous early 20th-century physician William Osler, who must have been a reader of Charles Dickens. The description of Joe, "the fat boy" in Dickens's novel The Pickwick Papers, is an accurate clinical picture of an adult with obstructive sleep apnea syndrome.^[114]

The early reports of obstructive sleep apnea in the medical literature described individuals who were severely affected, often presenting with severe hypoxemia, hypercapnia and congestive heart failure.Template:Medical citation needed

Treatment

The management of obstructive sleep apnea was improved with the introduction of continuous positive airway pressure (CPAP) machines, first described in 1981 by Colin Sullivan and associates in Sydney, Australia.^[115] The first models were bulky and noisy, but the design was rapidly improved and by the late 1980s, CPAP was widely adopted. The availability of an effective treatment stimulated an aggressive search for affected individuals and led to the establishment of hundreds of specialized clinics dedicated to the diagnosis and treatment of sleep disorders. Though many types of sleep problems are recognized, the vast majority of patients attending these centers have sleep-disordered breathing. Sleep apnea awareness day is 18 April in recognition of Colin Sullivan.^[116]

References

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↑ Berry RB, Quan SF, Abrue AR, et al.; for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Version 2.6. Darien, IL: American Academy of Sleep Medicine; 2020.
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↑ Diaphragm Pacing at eMedicine
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[48] Berry RB, Quan SF, Abrue AR, et al.; for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Version 2.6. Darien, IL: American Academy of Sleep Medicine; 2020.

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@@ Line 9: / Line 9: @@
 | synonyms      = Sleep apnoea, sleep apnea syndrome
 | field         = [[Otorhinolaryngology]], [[sleep medicine]]
-| symptoms      = [[apnea|Pauses breathing]] or periods of [[hypopnea|shallow breathing]] during [[sleep]], [[snoring]], tired during the day<ref name="NIH2012What4">{{cite web |date=10 July 2012 |title=Sleep Apnea: What Is Sleep Apnea? |url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/ |url-status=live |archive-url=https://web.archive.org/web/20160819043218/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/ |archive-date=19 August 2016 |access-date=18 August 2016 |work=NHLBI: Health Information for the Public |publisher=U.S. Department of Health and Human Services}}</ref><ref name="NIH2012Sym">{{cite web |date=10 July 2012 |title=What Are the Signs and Symptoms of Sleep Apnea? |url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/signs |url-status=live |archive-url=https://web.archive.org/web/20160826185448/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/signs |archive-date=26 August 2016 |access-date=18 August 2016 |website=NHLBI}}</ref>
+| symptoms      = [[apnea|Pauses breathing]] or periods of [[hypopnea|shallow breathing]] during [[sleep]], [[snoring]], tired during the day<ref name="NIH2012What4">{{cite web |date=10 July 2012 |title=Sleep Apnea: What Is Sleep Apnea? |url=https://www.nhlbi.nih.gov/health/sleep-apnea |url-status=live |archive-url=https://web.archive.org/web/20160819043218/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/ |archive-date=19 August 2016 |access-date=18 August 2016 |work=NHLBI: Health Information for the Public |publisher=U.S. Department of Health and Human Services}}</ref><ref name="NIH2012Sym">{{cite web |date=10 July 2012 |title=What Are the Signs and Symptoms of Sleep Apnea? |url=https://www.nhlbi.nih.gov/health/sleep-apnea/symptoms |url-status=live |archive-url=https://web.archive.org/web/20160826185448/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/signs |archive-date=26 August 2016 |access-date=18 August 2016 |website=NHLBI}}</ref>
 | complications = [[myocardial infarction|Heart attack]], [[Cardiac arrest]],  [[stroke]], [[diabetes]], [[heart failure]], [[irregular heartbeat]], [[obesity]], [[motor vehicle collisions]],<ref name="NIH2012What4"/> [[Alzheimer's disease]],<ref name="Jackson et al 2020" /> and premature death<ref>{{cite journal |last1=Young |first1=Terry |last2=Finn |first2=Laurel |last3=Peppard |first3=Paul E. |last4=Szklo-Coxe |first4=Mariana |last5=Austin |first5=Diane |last6=Nieto |first6=F. Javier |last7=Stubbs |first7=Robin |last8=Hla |first8=K. Mae |title=Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up of the Wisconsin Sleep Cohort |journal=Sleep |date=1 August 2008 |volume=31 |issue=8 |pages=1071–1078 |pmid=18714778 |pmc=2542952 |url=https://aasm.org/study-shows-that-people-with-sleep-apnea-have-a-high-risk-of-death/ |access-date=27 February 2021 |archive-date=23 January 2021 |archive-url=https://web.archive.org/web/20210123171810/https://aasm.org/study-shows-that-people-with-sleep-apnea-have-a-high-risk-of-death/ |url-status=live }}</ref>
 | onset         = Varies; up to 50% of women age 20–70<ref name="ReferenceC">{{cite journal|pmc = 4561280|year = 2015|last1 = Franklin|first1 = K. A.|last2 = Lindberg|first2 = E.|title = Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea|journal = Journal of Thoracic Disease|volume = 7|issue = 8|pages = 1311–1322|doi = 10.3978/j.issn.2072-1439.2015.06.11|pmid = 26380759}}</ref>
@@ Line 15: / Line 15: @@
 | causes        =
 | risks         = [[Overweight]], family history, [[allergies]], enlarged [[tonsils]],<ref name="NIH2012Cau2" /> [[asthma]]<ref name="asthma_Ref">{{cite journal |last1=Dixit |last2=Ramakant |year=2018 |title=Asthma and obstructive sleep apnea: More than an association! |journal=Lung India |volume=35 |issue=3 |pages=191–192 |doi=10.4103/lungindia.lungindia_241_17 |pmc=5946549 |pmid=29697073 |doi-access=free }}</ref>
-| diagnosis     = Overnight [[Polysomnography|sleep study]]<ref name=NIH2012Diag>{{cite web|title=How Is Sleep Apnea Diagnosed?|url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/diagnosis|website=NHLBI|access-date=18 August 2016|date=10 July 2012|url-status=live|archive-url=https://web.archive.org/web/20160811134644/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/diagnosis|archive-date=11 August 2016}}</ref>
+| diagnosis     = Overnight [[Polysomnography|sleep study]]<ref name=NIH2012Diag>{{cite web|title=How Is Sleep Apnea Diagnosed?|url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/diagnosis|website=NHLBI|access-date=18 August 2016|date=10 July 2012|archive-url=https://web.archive.org/web/20160811134644/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/diagnosis|archive-date=11 August 2016}}</ref>
 | differential  =
 | prevention    =
@@ Line 28: / Line 28: @@
 <!-- Definition -->
-'''Sleep apnea''' ('''sleep apnoea''' or '''sleep apnœa''' in [[British English]]) is a sleep-related breathing disorder in which repetitive [[Apnea|pauses in breathing]], periods of shallow breathing, or collapse of the upper airway during [[sleep]] results in poor ventilation and sleep disruption.<ref name="Chang-2023">{{Cite journal |last1=Chang |first1=Jolie L. |last2=Goldberg |first2=Andrew N. |last3=Alt |first3=Jeremiah A. |last4=Mohammed |first4=Alzoubaidi |last5=Ashbrook |first5=Liza |last6=Auckley |first6=Dennis |last7=Ayappa |first7=Indu |last8=Bakhtiar |first8=Hira |last9=Barrera |first9=José E. |last10=Bartley |first10=Bethany L. |last11=Billings |first11=Martha E. |last12=Boon |first12=Maurits S. |last13=Bosschieter |first13=Pien |last14=Braverman |first14=Itzhak |last15=Brodie |first15=Kara |date=2023-07-13 |title=International Consensus Statement on Obstructive Sleep Apnea |journal=International Forum of Allergy & Rhinology |language=en |volume=13 |issue=7 |pages=1061–1482 |doi=10.1002/alr.23079 |issn=2042-6976 |pmc=10359192 |pmid=36068685}}</ref><ref name="Roberts-2022" /> Each pause in breathing can last for a few seconds to a few minutes and often occurs many times a night.<ref name="NIH2012What4" /> A choking or snorting sound may occur as breathing resumes.<ref name="NIH2012What4" /> Common symptoms include daytime sleepiness, snoring, and non-restorative sleep despite adequate sleep time.<ref name="Stansbury-2015">{{Cite journal |last1=Stansbury |first1=Robert C. |last2=Strollo |first2=Patrick J. |date=2015-09-07 |title=Clinical manifestations of sleep apnea |url=https://jtd.amegroups.org/article/view/5253 |journal=Journal of Thoracic Disease |language=en |volume=7 |issue=9 |pages=E298-310 |doi=10.3978/j.issn.2072-1439.2015.09.13 |issn=2077-6624 |pmc=4598518 |pmid=26543619 |access-date=11 March 2024 |archive-date=11 March 2024 |archive-url=https://web.archive.org/web/20240311030519/https://jtd.amegroups.org/article/view/5253 |url-status=live }}</ref> Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day.<ref name="NIH2012What4" /> It is often a chronic condition.<ref>{{cite journal |last1=Punjabi |first1=Naresh M. |date=15 February 2008 |title=The Epidemiology of Adult Obstructive Sleep Apnea |journal=Proceedings of the American Thoracic Society |volume=5 |issue=2 |pages=136–143 |doi=10.1513/pats.200709-155MG |issn=1546-3222 |pmc=2645248 |pmid=18250205}}</ref><!--Cause and diagnosis-->
+'''Sleep apnea''' ('''sleep apnoea''' or '''sleep apnœa''' in [[British English]]) is a [[sleep-related breathing disorder]] in which repetitive [[Apnea|pauses in breathing]], periods of shallow breathing, or collapse of the [[upper airway]] during [[sleep]] results in poor ventilation and sleep disruption.<ref name="Chang-2023">{{Cite journal |last1=Chang |first1=Jolie L. |last2=Goldberg |first2=Andrew N. |last3=Alt |first3=Jeremiah A. |last4=Mohammed |first4=Alzoubaidi |last5=Ashbrook |first5=Liza |last6=Auckley |first6=Dennis |last7=Ayappa |first7=Indu |last8=Bakhtiar |first8=Hira |last9=Barrera |first9=José E. |last10=Bartley |first10=Bethany L. |last11=Billings |first11=Martha E. |last12=Boon |first12=Maurits S. |last13=Bosschieter |first13=Pien |last14=Braverman |first14=Itzhak |last15=Brodie |first15=Kara |date=2023-07-13 |title=International Consensus Statement on Obstructive Sleep Apnea |journal=International Forum of Allergy & Rhinology |language=en |volume=13 |issue=7 |pages=1061–1482 |doi=10.1002/alr.23079 |issn=2042-6976 |pmc=10359192 |pmid=36068685}}</ref><ref name="Roberts-2022" /> Each pause in breathing can last for a few seconds to a few minutes and often occurs many times a night.<ref name="NIH2012What4" /> A choking or snorting sound may occur as breathing resumes.<ref name="NIH2012What4" /> Common symptoms include daytime sleepiness, snoring, and [[non-restorative sleep]] despite adequate sleep time.<ref name="Stansbury-2015">{{Cite journal |last1=Stansbury |first1=Robert C. |last2=Strollo |first2=Patrick J. |date=2015-09-07 |title=Clinical manifestations of sleep apnea |url=https://jtd.amegroups.org/article/view/5253 |journal=Journal of Thoracic Disease |language=en |volume=7 |issue=9 |pages=E298-310 |doi=10.3978/j.issn.2072-1439.2015.09.13 |issn=2077-6624 |pmc=4598518 |pmid=26543619 |access-date=11 March 2024 |archive-date=11 March 2024 |archive-url=https://web.archive.org/web/20240311030519/https://jtd.amegroups.org/article/view/5253 |url-status=live }}</ref> Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day.<ref name="NIH2012What4" /> It is often a chronic condition.<ref>{{cite journal |last1=Punjabi |first1=Naresh M. |date=15 February 2008 |title=The Epidemiology of Adult Obstructive Sleep Apnea |journal=Proceedings of the American Thoracic Society |volume=5 |issue=2 |pages=136–143 |doi=10.1513/pats.200709-155MG |issn=1546-3222 |pmc=2645248 |pmid=18250205}}</ref><!--Cause and diagnosis-->
-Sleep apnea may be categorized as [[obstructive sleep apnea]] (OSA), in which breathing is interrupted by a blockage of air flow, [[central sleep apnea]] (CSA), in which regular unconscious breath simply stops, or a combination of the two.<ref name="NIH2012What4" /> OSA is the most common form.<ref name="NIH2012What4" /> OSA has four key contributors; these include a narrow, crowded, or collapsible upper airway, an ineffective pharyngeal dilator muscle function during sleep, airway narrowing during sleep, and unstable control of breathing (high loop gain).<ref name="Dolgin3">{{cite journal |last1=Dolgin |first1=Elie |date=29 April 2020 |title=Treating sleep apnea with pills instead of machines |url=https://knowablemagazine.org/article/health-disease/2020/treating-sleep-apnea-pills-instead-machines |journal=Knowable Magazine |doi=10.1146/knowable-042820-1 |access-date=9 May 2022 |doi-access=free |archive-date=30 May 2022 |archive-url=https://web.archive.org/web/20220530121424/https://knowablemagazine.org/article/health-disease/2020/treating-sleep-apnea-pills-instead-machines |url-status=live }}</ref><ref name="Osman-2018">{{cite journal |last1=Osman |first1=A. M. |last2=Carter |first2=S. G. |last3=Carberry |first3=J. C. |last4=Eckert |first4=D. J. |year=2018 |title=Obstructive sleep apnea: Current perspectives |journal=Nature and Science of Sleep |volume=10 |pages=21–34 |doi=10.2147/NSS.S124657 |pmc=5789079 |pmid=29416383 |doi-access=free}}</ref> In CSA, the basic neurological controls for breathing rate malfunction and fail to give the signal to inhale, causing the individual to miss one or more cycles of breathing. If the pause in breathing is long enough, the percentage of oxygen in the circulation can drop to a lower than normal level ([[hypoxemia]]) and the concentration of carbon dioxide can build to a higher than normal level ([[hypercapnia]]).<ref>{{cite book |last1=Majmundar |first1=Sapan H. |url=https://www.ncbi.nlm.nih.gov/books/NBK482456/ |title=Physiology, Carbon Dioxide Retention |last2=Patel |first2=Shivani |date=27 October 2018 |publisher=StatPearls Publishing |pmid=29494063 |access-date=23 January 2019 |archive-date=20 May 2020 |archive-url=https://web.archive.org/web/20200520051103/https://www.ncbi.nlm.nih.gov/books/NBK482456/ |url-status=live }}</ref> In turn, these conditions of [[Hypoxia (medical)|hypoxia]] and hypercapnia will trigger ''additional'' effects on the body such as [[Cheyne-stokes respiration|Cheyne-Stokes Respiration]].<ref>{{cite book |last1=Rudrappa |first1=M. |url=https://www.ncbi.nlm.nih.gov/books/NBK448165/ |title=Cheyne Stokes Respirations |last2=Modi |first2=P. |last3=Bollu |first3=P.C. |date=1 August 2022 |publisher=StatPearls Publishing |isbn= |location=Treasure Island, FL |pmid=28846350 |accessdate= |archive-date=15 June 2023 |archive-url=https://web.archive.org/web/20230615151856/https://www.ncbi.nlm.nih.gov/books/NBK448165/ |url-status=live }}</ref>
+Sleep apnea may be categorized as ''[[obstructive sleep apnea]]'' (OSA), in which breathing is interrupted by a blockage of air flow, ''[[central sleep apnea]]'' (CSA), in which regular unconscious breath simply stops, or a combination of the two.<ref name="NIH2012What4" /> OSA is the most common form.<ref name="NIH2012What4" /> OSA has four key contributors; these include a narrow, crowded, or collapsible upper airway, an ineffective pharyngeal dilator muscle function during sleep, airway narrowing during sleep, and unstable control of breathing (high loop gain).<ref name="Dolgin3">{{cite journal |last1=Dolgin |first1=Elie |date=29 April 2020 |title=Treating sleep apnea with pills instead of machines |url=https://knowablemagazine.org/article/health-disease/2020/treating-sleep-apnea-pills-instead-machines |journal=Knowable Magazine |doi=10.1146/knowable-042820-1 |access-date=9 May 2022 |doi-access=free |archive-date=30 May 2022 |archive-url=https://web.archive.org/web/20220530121424/https://knowablemagazine.org/article/health-disease/2020/treating-sleep-apnea-pills-instead-machines |url-status=live }}</ref><ref name="Osman-2018">{{cite journal |last1=Osman |first1=A. M. |last2=Carter |first2=S. G. |last3=Carberry |first3=J. C. |last4=Eckert |first4=D. J. |year=2018 |title=Obstructive sleep apnea: Current perspectives |journal=Nature and Science of Sleep |volume=10 |pages=21–34 |doi=10.2147/NSS.S124657 |pmc=5789079 |pmid=29416383 |doi-access=free}}</ref> In CSA, the basic neurological controls for breathing rate malfunction and fail to give the signal to inhale, causing the individual to miss one or more cycles of breathing. If the pause in breathing is long enough, the percentage of oxygen in the circulation can drop to a lower than normal level ([[hypoxemia]]) and the concentration of carbon dioxide can build to a higher than normal level ([[hypercapnia]]).<ref>{{cite book |last1=Majmundar |first1=Sapan H. |url=https://www.ncbi.nlm.nih.gov/books/NBK482456/ |title=Physiology, Carbon Dioxide Retention |last2=Patel |first2=Shivani |date=27 October 2018 |publisher=StatPearls Publishing |pmid=29494063 |access-date=23 January 2019 |archive-date=20 May 2020 |archive-url=https://web.archive.org/web/20200520051103/https://www.ncbi.nlm.nih.gov/books/NBK482456/ |url-status=live }}</ref> In turn, these conditions of [[Hypoxia (medical)|hypoxia]] and hypercapnia will trigger ''additional'' effects on the body such as [[Cheyne-stokes respiration|Cheyne-Stokes Respiration]].<ref>{{cite book |last1=Rudrappa |first1=M. |url=https://www.ncbi.nlm.nih.gov/books/NBK448165/ |title=Cheyne Stokes Respirations |last2=Modi |first2=P. |last3=Bollu |first3=P.C. |date=1 August 2022 |publisher=StatPearls Publishing |isbn= |location=Treasure Island, FL |pmid=28846350 |archive-date=15 June 2023 |archive-url=https://web.archive.org/web/20230615151856/https://www.ncbi.nlm.nih.gov/books/NBK448165/ |url-status=live }}</ref>
 Some people with sleep apnea are unaware they have the condition.<ref name="NIH2012What4" /> In many cases it is first observed by a family member.<ref name="NIH2012What4" /> An in-lab sleep study overnight is the preferred method for diagnosing sleep apnea.<ref name="Osman-2018" /> In the case of OSA, the outcome that determines disease severity and guides the treatment plan is the apnea-hypopnea index (AHI).<ref name="Osman-2018" /> This measurement is calculated from totaling all pauses in breathing and periods of shallow breathing lasting greater than 10 seconds and dividing the sum by total hours of recorded sleep.<ref name="Chang-2023" /><ref name="Osman-2018" /> In contrast, for CSA the degree of respiratory effort, measured by esophageal pressure or displacement of the thoracic or abdominal cavity, is an important distinguishing factor between OSA and CSA.<ref name="Badr-2019">{{Cite journal |last1=Badr |first1=M. Safwan |last2=Javaheri |first2=Shahrokh |date=March 2019 |title=Central Sleep Apnea: a Brief Review |journal=Current Pulmonology Reports |language=en |volume=8 |issue=1 |pages=14–21 |doi=10.1007/s13665-019-0221-z |issn=2199-2428 |pmc=6883649 |pmid=31788413}}</ref>
@@ Line 36: / Line 36: @@
 A systemic disorder, sleep apnea is associated with a wide array of effects, including increased risk of [[car accidents]], [[hypertension]], [[cardiovascular disease]], [[myocardial infarction]], [[stroke]], [[atrial fibrillation]], [[insulin resistance]], higher incidence of [[cancer]], and [[neurodegeneration]].<ref name="Lim4">{{cite journal |last1=Lim |first1=Diane C. |last2=Pack |first2=Allan I. |date=14 January 2017 |title=Obstructive Sleep Apnea: Update and Future |url=https://www.annualreviews.org/doi/10.1146/annurev-med-042915-102623 |journal=Annual Review of Medicine |volume=68 |issue=1 |pages=99–112 |doi=10.1146/annurev-med-042915-102623 |issn=0066-4219 |pmid=27732789 |url-access=subscription |access-date=10 May 2022 |archive-date=10 May 2022 |archive-url=https://web.archive.org/web/20220510122636/https://www.annualreviews.org/doi/10.1146/annurev-med-042915-102623 |url-status=live }}</ref> Further research is being conducted on the potential of using biomarkers to understand which chronic diseases are associated with sleep apnea on an individual basis.<ref name="Lim4"/><!--Prevention, treatment, prognosis-->
-Treatment may include lifestyle changes, mouthpieces, breathing devices, and surgery.<ref name="NIH2012What4" /> Effective lifestyle changes may include avoiding [[Alcohol (drug)|alcohol]], losing weight, [[smoking]] cessation, and sleeping on one's side.<ref name="Gottlieb&20202">{{cite journal |last1=Gottlieb |first1=Daniel J. |last2=Punjabi |first2=Naresh M. |date=14 April 2020 |title=Diagnosis and Management of Obstructive Sleep Apnea: A Review |url=https://doi.org/10.1001/jama.2020.3514 |journal=JAMA |volume=323 |issue=14 |pages=1389–1400 |doi=10.1001/jama.2020.3514 |issn=0098-7484 |pmid=32286648 |s2cid=215759986 |url-access=subscription |access-date=22 October 2021 |archive-date=8 March 2024 |archive-url=https://web.archive.org/web/20240308031521/https://jamanetwork.com/journals/jama/article-abstract/2764461 |url-status=live }}</ref> Breathing devices include the use of a [[Continuous positive airway pressure|CPAP machine]].<ref name="NIH2012Tx2">{{cite web |date=10 July 2012 |title=How Is Sleep Apnea Treated? |url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/treatment |url-status=live |archive-url=https://web.archive.org/web/20160827160600/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/treatment |archive-date=27 August 2016 |access-date=18 August 2016 |website=NHLBI}}</ref> With proper use, CPAP improves outcomes.<ref name="Spi20152">{{cite journal |vauthors=Spicuzza L, Caruso D, Di Maria G |date=September 2015 |title=Obstructive sleep apnoea syndrome and its management |journal=Therapeutic Advances in Chronic Disease |volume=6 |issue=5 |pages=273–85 |doi=10.1177/2040622315590318 |pmc=4549693 |pmid=26336596}}</ref> Evidence suggests that CPAP may improve sensitivity to insulin, blood pressure, and sleepiness.<ref>{{cite journal |vauthors=Iftikhar IH, Khan MF, Das A, Magalang UJ |date=April 2013 |title=Meta-analysis: continuous positive airway pressure improves insulin resistance in patients with sleep apnea without diabetes |journal=Annals of the American Thoracic Society |volume=10 |issue=2 |pages=115–20 |doi=10.1513/annalsats.201209-081oc |pmc=3960898 |pmid=23607839}}</ref><ref>{{cite journal |vauthors=Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A, Velkeniers B |date=April 2007 |title=The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials |journal=Archives of Internal Medicine |volume=167 |issue=8 |pages=757–64 |doi=10.1001/archinte.167.8.757 |pmid=17452537 |doi-access=}}</ref><ref>{{cite journal |vauthors=Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT |date=March 2003 |title=Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis |journal=Archives of Internal Medicine |volume=163 |issue=5 |pages=565–71 |doi=10.1001/archinte.163.5.565 |pmid=12622603 |doi-access=}}</ref> Long term compliance, however, is an issue with more than half of people not appropriately using the device.<ref name="Spi20152" /><ref name="Hsu20032">{{cite journal |vauthors=Hsu AA, Lo C |date=December 2003 |title=Continuous positive airway pressure therapy in sleep apnoea |journal=Respirology |volume=8 |issue=4 |pages=447–54 |doi=10.1046/j.1440-1843.2003.00494.x |pmid=14708553 |doi-access=free}}</ref> In 2017, only 15% of potential patients in developed countries used CPAP machines, while in developing countries well under 1% of potential patients used CPAP.<ref>{{cite web |date=18 November 2017 |title=3 Top Medical Device Stocks to Buy Now |url=https://www.fool.com/investing/2017/11/18/3-top-medical-device-stocks-to-buy-now.aspx |access-date=7 March 2021 |archive-date=7 July 2021 |archive-url=https://web.archive.org/web/20210707012026/https://www.fool.com/investing/2017/11/18/3-top-medical-device-stocks-to-buy-now.aspx |url-status=live }}</ref>{{unreliable source|date=December 2024}} Without treatment, sleep apnea may increase the risk of [[Myocardial infarction|heart attack]], [[stroke]], [[diabetes]], [[heart failure]], [[irregular heartbeat]], [[obesity]], and [[motor vehicle collisions]].<ref name="NIH2012What4" /><!--Epidemiology and culture-->
+Treatment may include lifestyle changes, mouthpieces, breathing devices, and surgery.<ref name="NIH2012What4" /> Effective lifestyle changes may include avoiding [[Alcohol (drug)|alcohol]], losing weight, [[smoking]] cessation, and sleeping on one's side.<ref name="Gottlieb&20202">{{cite journal |last1=Gottlieb |first1=Daniel J. |last2=Punjabi |first2=Naresh M. |date=14 April 2020 |title=Diagnosis and Management of Obstructive Sleep Apnea: A Review |journal=JAMA |volume=323 |issue=14 |pages=1389–1400 |doi=10.1001/jama.2020.3514 |issn=0098-7484 |pmid=32286648 |s2cid=215759986 }}</ref> Breathing devices include the use of a [[Continuous positive airway pressure|CPAP machine]].<ref name="NIH2012Tx2">{{cite web |date=10 July 2012 |title=How Is Sleep Apnea Treated? |url=https://www.nhlbi.nih.gov/health/sleep-apnea/treatment |url-status=live |archive-url=https://web.archive.org/web/20160827160600/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/treatment |archive-date=27 August 2016 |access-date=18 August 2016 |website=NHLBI}}</ref> With proper use, CPAP improves outcomes.<ref name="Spi20152">{{cite journal |vauthors=Spicuzza L, Caruso D, Di Maria G |date=September 2015 |title=Obstructive sleep apnoea syndrome and its management |journal=Therapeutic Advances in Chronic Disease |volume=6 |issue=5 |pages=273–85 |doi=10.1177/2040622315590318 |pmc=4549693 |pmid=26336596}}</ref> Evidence suggests that CPAP may improve sensitivity to insulin, blood pressure, and sleepiness.<ref>{{cite journal |vauthors=Iftikhar IH, Khan MF, Das A, Magalang UJ |date=April 2013 |title=Meta-analysis: continuous positive airway pressure improves insulin resistance in patients with sleep apnea without diabetes |journal=Annals of the American Thoracic Society |volume=10 |issue=2 |pages=115–20 |doi=10.1513/annalsats.201209-081oc |pmc=3960898 |pmid=23607839}}</ref><ref>{{cite journal |vauthors=Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A, Velkeniers B |date=April 2007 |title=The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials |journal=Archives of Internal Medicine |volume=167 |issue=8 |pages=757–64 |doi=10.1001/archinte.167.8.757 |pmid=17452537 |doi-access=}}</ref><ref>{{cite journal |vauthors=Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT |date=March 2003 |title=Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis |journal=Archives of Internal Medicine |volume=163 |issue=5 |pages=565–71 |doi=10.1001/archinte.163.5.565 |pmid=12622603 |doi-access=}}</ref> Long term compliance, however, is an issue with more than half of people not appropriately using the device.<ref name="Spi20152" /><ref name="Hsu20032">{{cite journal |vauthors=Hsu AA, Lo C |date=December 2003 |title=Continuous positive airway pressure therapy in sleep apnoea |journal=Respirology |volume=8 |issue=4 |pages=447–54 |doi=10.1046/j.1440-1843.2003.00494.x |pmid=14708553 |doi-access=free}}</ref> In 2017, only 15% of potential patients in developed countries used CPAP machines, while in developing countries well under 1% of potential patients used CPAP.<ref>{{cite web |date=18 November 2017 |title=3 Top Medical Device Stocks to Buy Now |url=https://www.fool.com/investing/2017/11/18/3-top-medical-device-stocks-to-buy-now.aspx |access-date=7 March 2021 |archive-date=7 July 2021 |archive-url=https://web.archive.org/web/20210707012026/https://www.fool.com/investing/2017/11/18/3-top-medical-device-stocks-to-buy-now.aspx |url-status=live }}</ref>{{unreliable source|date=December 2024}} Without treatment, sleep apnea may increase the risk of [[Myocardial infarction|heart attack]], [[stroke]], [[diabetes]], [[heart failure]], [[irregular heartbeat]], [[obesity]], and [[motor vehicle collisions]].<ref name="NIH2012What4" /><!--Epidemiology and culture-->
-OSA is a common sleep disorder. A large analysis in 2019 of the estimated prevalence of OSA found that OSA affects 936 million—1 billion people between the ages of 30–69 globally, or roughly every 1 in 10 people, and up to 30% of the elderly.<ref>{{cite journal |last1=Franklin |first1=Karl A. |last2=Lindberg |first2=Eva |date=August 2015 |title=Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea |journal=Journal of Thoracic Disease |volume=7 |issue=8 |pages=1311–1322 |doi=10.3978/j.issn.2072-1439.2015.06.11 |issn=2072-1439 |pmc=4561280 |pmid=26380759}}</ref> Sleep apnea is somewhat more common in men than women, roughly a 2:1 ratio of men to women, and in general more people are likely to have it with older age and obesity. Other risk factors include being overweight,<ref name="Lim4"/> a family history of the condition, allergies, and enlarged [[tonsils]].<ref name="NIH2012Cau2">{{cite web |date=10 July 2012 |title=Who Is at Risk for Sleep Apnea? |url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/atrisk |url-status=live |archive-url=https://web.archive.org/web/20160826160854/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/atrisk |archive-date=26 August 2016 |access-date=18 August 2016 |website=NHLBI}}</ref>
+OSA is a common sleep disorder. A large analysis in 2019 of the estimated prevalence of OSA found that OSA affects 936 million—1 billion people between the ages of 30–69 globally, or roughly every 1 in 10 people, and up to 30% of the elderly.<ref>{{cite journal |last1=Franklin |first1=Karl A. |last2=Lindberg |first2=Eva |date=August 2015 |title=Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea |journal=Journal of Thoracic Disease |volume=7 |issue=8 |pages=1311–1322 |doi=10.3978/j.issn.2072-1439.2015.06.11 |issn=2072-1439 |pmc=4561280 |pmid=26380759}}</ref> Sleep apnea is somewhat more common in men than women, roughly a 2:1 ratio of men to women, and in general more people are likely to have it with older age and obesity. Other risk factors include being overweight,<ref name="Lim4"/> a family history of the condition, allergies, and enlarged [[tonsils]].<ref name="NIH2012Cau2">{{cite web |date=10 July 2012 |title=Who Is at Risk for Sleep Apnea? |url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/atrisk |archive-url=https://web.archive.org/web/20160826160854/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/atrisk |archive-date=26 August 2016 |access-date=18 August 2016 |website=NHLBI}}</ref>
 ==Signs and symptoms==
@@ Line 82: / Line 82: @@
 OSA is a serious medical condition with systemic effects; patients with untreated OSA have a greater mortality risk from [[cardiovascular disease]] than those undergoing appropriate treatment.<ref name="Das-2022">{{Cite journal |last1=Das |first1=Aneesa M. |last2=Chang |first2=Judy L. |last3=Berneking |first3=Michael |last4=Hartenbaum |first4=Natalie P. |last5=Rosekind |first5=Mark |last6=Ramar |first6=Kannan |last7=Malhotra |first7=Raman K. |last8=Carden |first8=Kelly A. |last9=Martin |first9=Jennifer L. |last10=Abbasi-Feinberg |first10=Fariha |last11=Nisha Aurora |first11=R. |last12=Kapur |first12=Vishesh K. |last13=Olson |first13=Eric J. |last14=Rosen |first14=Carol L. |last15=Rowley |first15=James A. |date=2022-10-01 |title=Enhancing public health and safety by diagnosing and treating obstructive sleep apnea in the transportation industry: an American Academy of Sleep Medicine position statement |journal=Journal of Clinical Sleep Medicine |language=en |volume=18 |issue=10 |pages=2467–2470 |doi=10.5664/jcsm.9670 |issn=1550-9389 |pmc=9516580 |pmid=34534065}}</ref> Other complications include [[hypertension]], congestive [[heart failure]], [[atrial fibrillation]], [[coronary artery disease]], [[stroke]], and [[type 2 diabetes]].<ref name="Das-2022" /> Daytime fatigue and sleepiness, a common symptom of sleep apnea, is also an important public health concern regarding transportation crashes caused by drowsiness.<ref name="Das-2022" /> OSA may also be a risk factor of [[COVID-19]]. People with OSA have a higher risk of developing severe complications of [[COVID-19]].<ref>{{cite web |title=Obstructive sleep apnea – Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090 |url-status=live |archive-url=https://web.archive.org/web/20190811195722/https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090 |archive-date=11 August 2019 |access-date=30 March 2022 |website=Mayo Clinic |language=en}}</ref>
-[[Alzheimer's disease]] and severe obstructive sleep apnea are connected<ref name="ReferenceB">{{cite journal |last1=Andrade |first1=A. |last2=Bubu |first2=O. M. |last3=Varga |first3=A. W. |last4=Osorio |first4=R. S. |year=2018 |title=The relationship between Obstructive Sleep Apnea and Alzheimer's Disease |journal=Journal of Alzheimer's Disease |volume=64 |issue=Suppl 1 |pages=S255–S270 |doi=10.3233/JAD-179936 |pmc=6542637 |pmid=29782319}}</ref> because there is an increase in the protein [[beta-amyloid]] as well as [[White matter|white-matter]] damage. These are the main indicators of Alzheimer's, which in this case comes from the lack of proper rest or poorer sleep efficiency resulting in [[neurodegeneration]].<ref name="Jackson et al 2020">{{cite journal |last1=Jackson |first1=Melinda L. |last2=Cavuoto |first2=Marina |last3=Schembri |first3=Rachel |last4=Doré |first4=Vincent |last5=Villemagne |first5=Victor L. |last6=Barnes |first6=Maree |last7=O'Donoghue |first7=Fergal J. |last8=Rowe |first8=Christopher C. |last9=Robinson |first9=Stephen R. |title=Severe Obstructive Sleep Apnea Is Associated with Higher Brain Amyloid Burden: A Preliminary PET Imaging Study |journal=Journal of Alzheimer's Disease |date=10 November 2020 |volume=78 |issue=2 |pages=611–617 |doi=10.3233/JAD-200571 |pmid=33016907 |s2cid=222145149 |url=https://www.sciencedaily.com/releases/2020/11/201111104918.htm |url-access=subscription |access-date=26 February 2021 |archive-date=28 January 2021 |archive-url=https://web.archive.org/web/20210128005317/https://www.sciencedaily.com/releases/2020/11/201111104918.htm |url-status=live }}</ref><ref name="Weihs Frenzel Grabe 2021 pp. 87–96">{{cite journal |last1=Weihs |first1=Antoine |last2=Frenzel |first2=Stefan |last3=Grabe |first3=Hans J. |date=13 July 2021 |title=The Link Between Obstructive Sleep Apnoea and Neurodegeneration and Cognition |url=https://pub.dzne.de/record/155442/files/19530.pdf |url-status=live |journal=Current Sleep Medicine Reports |publisher=Springer Science and Business Media LLC |volume=7 |issue=3 |pages=87–96 |doi=10.1007/s40675-021-00210-5 |issn=2198-6401 |s2cid=235801219 |archive-url=https://web.archive.org/web/20240206225000/https://pub.dzne.de/record/155442/files/19530.pdf |archive-date=6 February 2024 |access-date=6 February 2024 |doi-access=free}}</ref><ref>{{cite journal |last1=Lee |first1=Min-Hee |last2=Lee |first2=Seung Ku |last3=Kim |first3=Soriul |last4=Kim |first4=Regina E. Y. |last5=Nam |first5=Hye Ryeong |last6=Siddiquee |first6=Ali T. |last7=Thomas |first7=Robert J. |last8=Hwang |first8=Inha |last9=Yoon |first9=Jee-Eun |last10=Yun |first10=Chang-Ho |last11=Shin |first11=Chol |date=20 July 2022 |title=Association of Obstructive Sleep Apnea With White Matter Integrity and Cognitive Performance Over a 4-Year Period in Middle to Late Adulthood |journal=[[JAMA Network Open]] |volume=5 |issue=7 |pages=e2222999 |doi=10.1001/jamanetworkopen.2022.22999 |pmc=9301517 |pmid=35857321 }}</ref> Having sleep apnea in mid-life brings a higher likelihood of developing Alzheimer's in older age, and if one has Alzheimer's then one is also more likely to have sleep apnea.<ref name="Owen et al 2020">{{cite journal |last1=Owen |first1=Jessica E |last2=Benediktsdottir |first2=Bryndis |last3=Cook |first3=Elizabeth |last4=Olafsson |first4=Isleifur |last5=Gislason |first5=Thorarinn |last6=Robinson |first6=Stephen R |title=Alzheimer's disease neuropathology in the hippocampus and brainstem of people with obstructive sleep apnea |journal=Sleep |date=21 September 2020 |volume=44 |issue=3 |pages=zsaa195 |doi=10.1093/sleep/zsaa195 |pmid=32954401 |url=https://www.sciencedaily.com/releases/2020/09/200928103416.htm |doi-access=free |access-date=1 March 2021 |archive-date=20 November 2020 |archive-url=https://web.archive.org/web/20201120140234/https://www.sciencedaily.com/releases/2020/09/200928103416.htm |url-status=live }}</ref> This is demonstrated by cases of sleep apnea even being misdiagnosed as [[dementia]].<ref>{{cite news |first=Paul |last=Span |date=6 October 2010 |title=When Sleep Apnea Masquerades as Dementia |url=https://newoldage.blogs.nytimes.com/2010/10/06/when-sleep-apnea-masquerades-as-dementia/ |work=New York Times |url-status=live |archive-url=https://web.archive.org/web/20210309174427/https://newoldage.blogs.nytimes.com/2010/10/06/when-sleep-apnea-masquerades-as-dementia/ |archive-date=9 March 2021 |access-date=1 March 2021}}</ref> With the use of treatment through CPAP, there is a reversible risk factor in terms of the amyloid proteins. This usually restores brain structure and cognitive impairment.<ref>{{cite journal |last1=Liguori |first1=Claudio |last2=Chiaravalloti |first2=Agostino |last3=Izzi |first3=Francesca |last4=Nuccetelli |first4=Marzia |last5=Bernardini |first5=Sergio |last6=Schillaci |first6=Orazio |last7=Mercuri |first7=Nicola Biagio |last8=Placidi |first8=Fabio |date=1 December 2017 |title=Sleep apnoeas may represent a reversible risk factor for amyloid-β pathology |journal=Brain |volume=140 |issue=12 |pages=e75 |doi=10.1093/brain/awx281 |pmid=29077794 |doi-access=free|hdl=2108/212653 |hdl-access=free }}</ref><ref>{{cite journal |last1=Castronovo |first1=Vincenza |last2=Scifo |first2=Paola |last3=Castellano |first3=Antonella |last4=Aloia |first4=Mark S. |last5=Iadanza |first5=Antonella |last6=Marelli |first6=Sara |last7=Cappa |first7=Stefano F. |last8=Strambi |first8=Luigi Ferini |last9=Falini |first9=Andrea |date=1 September 2014 |title=White Matter Integrity in Obstructive Sleep Apnea before and after Treatment |url=https://aasm.org/brain-damage-caused-by-severe-sleep-apnea-is-reversible/ |url-status=live |journal=Sleep |volume=37 |issue=9 |pages=1465–1475 |doi=10.5665/sleep.3994 |pmc=4153061 |pmid=25142557 |archive-url=https://web.archive.org/web/20210304122831/https://aasm.org/brain-damage-caused-by-severe-sleep-apnea-is-reversible/ |archive-date=4 March 2021 |access-date=1 March 2021}}</ref><ref name="Cooke Ayalon Palmer Loredo 2009 pp. 305–309">{{cite journal |last1=Cooke |first1=Jana R. |last2=Ayalon |first2=Liat |last3=Palmer |first3=Barton W. |last4=Loredo |first4=Jose S. |last5=Corey-Bloom |first5=Jody |last6=Natarajan |first6=Loki |last7=Liu |first7=Lianqi |last8=Ancoli-Israel |first8=Sonia |date=15 August 2009 |title=Sustained Use of CPAP Slows Deterioration of Cognition, Sleep, and Mood in Patients with Alzheimer's Disease and Obstructive Sleep Apnea: A Preliminary Study |journal=Journal of Clinical Sleep Medicine |publisher=American Academy of Sleep Medicine (AASM) |volume=05 |issue=4 |pages=305–309 |doi=10.5664/jcsm.27538 |issn=1550-9389 |s2cid=24123888 |doi-access=free}}</ref> Evidence continues to be found supporting there is an association between [[Body mass index|BMI]] and Alzheimer's.<ref>{{Cite journal |last1=Lee |first1=Eun Hye |last2=Yoo |first2=Heejin |last3=Kim |first3=Young Ju |last4=Cheon |first4=Bo Kyoung |last5=Ryu |first5=Seungho |last6=Chang |first6=Yoosoo |last7=Yun |first7=Jihwan |last8=Jang |first8=Hyemin |last9=Kim |first9=Jun Pyo |last10=Kim |first10=Hee Jin |last11=Koh |first11=Seong-Beom |last12=Jeong |first12=Jee Hyang |last13=Na |first13=Duk L. |last14=Seo |first14=Sang Won |last15=Kang |first15=Sung Hoon |date=2024-08-29 |title=Different associations between body mass index and Alzheimer's markers depending on metabolic health |journal=Alzheimer's Research & Therapy |volume=16 |issue=1 |pages=194 |doi=10.1186/s13195-024-01563-z |doi-access=free |issn=1758-9193 |pmc=11363444 |pmid=39210402}}</ref> There is also evidence of increased risk of developing Alzheimer's for those with a higher BMI in women ages 70 and above.<ref>{{Cite journal |last1=Gustafson |first1=Deborah |last2=Rothenberg |first2=Elisabet |last3=Blennow |first3=Kaj |last4=Steen |first4=Bertil |last5=Skoog |first5=Ingmar |date=2003-07-14 |title=An 18-Year Follow-up of Overweight and Risk of Alzheimer Disease |url=http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinte.163.13.1524 |journal=Archives of Internal Medicine |language=en |volume=163 |issue=13 |pages=1524–1528 |doi=10.1001/archinte.163.13.1524 |pmid=12860573 |issn=0003-9926|url-access=subscription }}</ref> While [[continuous positive airway pressure]] (CPAP) wasn't found to significantly improve cognitive performance, it was found to benefit other symptoms like depression, anxiety, etc.<ref>{{Cite journal |last1=Oliver |first1=Cerys |last2=Li |first2=Haoxuan |last3=Biswas |first3=Bijetri |last4=Woodstoke |first4=David |last5=Blackman |first5=Jonathan |last6=Butters |first6=Anneka |last7=Drew |first7=Cheney |last8=Gabb |first8=Victoria |last9=Harding |first9=Sam |last10=Hoyos |first10=Camilla M. |last11=Kendrick |first11=Adrian |last12=Rudd |first12=Sarah |last13=Turner |first13=Nicholas |last14=Coulthard |first14=Elizabeth |date=2024-02-01 |title=A systematic review on adherence to continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) in individuals with mild cognitive impairment and Alzheimer's disease dementia |url=https://linkinghub.elsevier.com/retrieve/pii/S1087079223001259 |journal=Sleep Medicine Reviews |volume=73 |pages=101869 |doi=10.1016/j.smrv.2023.101869 |pmid=37924680 |issn=1087-0792|doi-access=free }}</ref>
+[[Alzheimer's disease]] and severe obstructive sleep apnea are connected<ref name="ReferenceB">{{cite journal |last1=Andrade |first1=A. |last2=Bubu |first2=O. M. |last3=Varga |first3=A. W. |last4=Osorio |first4=R. S. |year=2018 |title=The relationship between Obstructive Sleep Apnea and Alzheimer's Disease |journal=Journal of Alzheimer's Disease |volume=64 |issue=Suppl 1 |pages=S255–S270 |doi=10.3233/JAD-179936 |pmc=6542637 |pmid=29782319}}</ref> because there is an increase in the protein [[beta-amyloid]] as well as [[White matter|white-matter]] damage. These are the main indicators of Alzheimer's, which in this case comes from the lack of proper rest or poorer sleep efficiency resulting in [[neurodegeneration]].<ref name="Jackson et al 2020">{{cite journal |last1=Jackson |first1=Melinda L. |last2=Cavuoto |first2=Marina |last3=Schembri |first3=Rachel |last4=Doré |first4=Vincent |last5=Villemagne |first5=Victor L. |last6=Barnes |first6=Maree |last7=O'Donoghue |first7=Fergal J. |last8=Rowe |first8=Christopher C. |last9=Robinson |first9=Stephen R. |title=Severe Obstructive Sleep Apnea Is Associated with Higher Brain Amyloid Burden: A Preliminary PET Imaging Study |journal=Journal of Alzheimer's Disease |date=10 November 2020 |volume=78 |issue=2 |pages=611–617 |doi=10.3233/JAD-200571 |pmid=33016907 |s2cid=222145149 |url=https://www.sciencedaily.com/releases/2020/11/201111104918.htm |url-access=subscription |access-date=26 February 2021 |archive-date=28 January 2021 |archive-url=https://web.archive.org/web/20210128005317/https://www.sciencedaily.com/releases/2020/11/201111104918.htm |url-status=live }}</ref><ref name="Weihs Frenzel Grabe 2021 pp. 87–96">{{cite journal |last1=Weihs |first1=Antoine |last2=Frenzel |first2=Stefan |last3=Grabe |first3=Hans J. |date=13 July 2021 |title=The Link Between Obstructive Sleep Apnoea and Neurodegeneration and Cognition |url=https://pub.dzne.de/record/155442/files/19530.pdf |url-status=live |journal=Current Sleep Medicine Reports |publisher=Springer Science and Business Media LLC |volume=7 |issue=3 |pages=87–96 |doi=10.1007/s40675-021-00210-5 |issn=2198-6401 |s2cid=235801219 |archive-url=https://web.archive.org/web/20240206225000/https://pub.dzne.de/record/155442/files/19530.pdf |archive-date=6 February 2024 |access-date=6 February 2024 |doi-access=free}}</ref><ref>{{cite journal |last1=Lee |first1=Min-Hee |last2=Lee |first2=Seung Ku |last3=Kim |first3=Soriul |last4=Kim |first4=Regina E. Y. |last5=Nam |first5=Hye Ryeong |last6=Siddiquee |first6=Ali T. |last7=Thomas |first7=Robert J. |last8=Hwang |first8=Inha |last9=Yoon |first9=Jee-Eun |last10=Yun |first10=Chang-Ho |last11=Shin |first11=Chol |date=20 July 2022 |title=Association of Obstructive Sleep Apnea With White Matter Integrity and Cognitive Performance Over a 4-Year Period in Middle to Late Adulthood |journal=[[JAMA Network Open]] |volume=5 |issue=7 |pages=e2222999 |doi=10.1001/jamanetworkopen.2022.22999 |pmc=9301517 |pmid=35857321 }}</ref> Having sleep apnea in mid-life brings a higher likelihood of developing Alzheimer's in older age, and if one has Alzheimer's then one is also more likely to have sleep apnea.<ref name="Owen et al 2020">{{cite journal |last1=Owen |first1=Jessica E |last2=Benediktsdottir |first2=Bryndis |last3=Cook |first3=Elizabeth |last4=Olafsson |first4=Isleifur |last5=Gislason |first5=Thorarinn |last6=Robinson |first6=Stephen R |title=Alzheimer's disease neuropathology in the hippocampus and brainstem of people with obstructive sleep apnea |journal=Sleep |date=21 September 2020 |volume=44 |issue=3 |article-number=zsaa195 |doi=10.1093/sleep/zsaa195 |pmid=32954401 |url=https://www.sciencedaily.com/releases/2020/09/200928103416.htm |doi-access=free |access-date=1 March 2021 |archive-date=20 November 2020 |archive-url=https://web.archive.org/web/20201120140234/https://www.sciencedaily.com/releases/2020/09/200928103416.htm |url-status=live }}</ref> This is demonstrated by cases of sleep apnea even being misdiagnosed as [[dementia]].<ref>{{cite news |first=Paul |last=Span |date=6 October 2010 |title=When Sleep Apnea Masquerades as Dementia |url=https://newoldage.blogs.nytimes.com/2010/10/06/when-sleep-apnea-masquerades-as-dementia/ |work=New York Times |url-status=live |archive-url=https://web.archive.org/web/20210309174427/https://newoldage.blogs.nytimes.com/2010/10/06/when-sleep-apnea-masquerades-as-dementia/ |archive-date=9 March 2021 |access-date=1 March 2021}}</ref> With the use of treatment through CPAP, there is a reversible risk factor in terms of the amyloid proteins. This usually restores brain structure and cognitive impairment.<ref>{{cite journal |last1=Liguori |first1=Claudio |last2=Chiaravalloti |first2=Agostino |last3=Izzi |first3=Francesca |last4=Nuccetelli |first4=Marzia |last5=Bernardini |first5=Sergio |last6=Schillaci |first6=Orazio |last7=Mercuri |first7=Nicola Biagio |last8=Placidi |first8=Fabio |date=1 December 2017 |title=Sleep apnoeas may represent a reversible risk factor for amyloid-β pathology |journal=Brain |volume=140 |issue=12 |pages=e75 |doi=10.1093/brain/awx281 |pmid=29077794 |doi-access=free|hdl=2108/212653 |hdl-access=free }}</ref><ref>{{cite journal |last1=Castronovo |first1=Vincenza |last2=Scifo |first2=Paola |last3=Castellano |first3=Antonella |last4=Aloia |first4=Mark S. |last5=Iadanza |first5=Antonella |last6=Marelli |first6=Sara |last7=Cappa |first7=Stefano F. |last8=Strambi |first8=Luigi Ferini |last9=Falini |first9=Andrea |date=1 September 2014 |title=White Matter Integrity in Obstructive Sleep Apnea before and after Treatment |url=https://aasm.org/brain-damage-caused-by-severe-sleep-apnea-is-reversible/ |url-status=live |journal=Sleep |volume=37 |issue=9 |pages=1465–1475 |doi=10.5665/sleep.3994 |pmc=4153061 |pmid=25142557 |archive-url=https://web.archive.org/web/20210304122831/https://aasm.org/brain-damage-caused-by-severe-sleep-apnea-is-reversible/ |archive-date=4 March 2021 |access-date=1 March 2021}}</ref><ref name="Cooke Ayalon Palmer Loredo 2009 pp. 305–309">{{cite journal |last1=Cooke |first1=Jana R. |last2=Ayalon |first2=Liat |last3=Palmer |first3=Barton W. |last4=Loredo |first4=Jose S. |last5=Corey-Bloom |first5=Jody |last6=Natarajan |first6=Loki |last7=Liu |first7=Lianqi |last8=Ancoli-Israel |first8=Sonia |date=15 August 2009 |title=Sustained Use of CPAP Slows Deterioration of Cognition, Sleep, and Mood in Patients with Alzheimer's Disease and Obstructive Sleep Apnea: A Preliminary Study |journal=Journal of Clinical Sleep Medicine |publisher=American Academy of Sleep Medicine (AASM) |volume=05 |issue=4 |pages=305–309 |doi=10.5664/jcsm.27538 |issn=1550-9389 |s2cid=24123888 |doi-access=free}}</ref> Evidence continues to be found supporting there is an association between [[Body mass index|BMI]] and Alzheimer's.<ref>{{Cite journal |last1=Lee |first1=Eun Hye |last2=Yoo |first2=Heejin |last3=Kim |first3=Young Ju |last4=Cheon |first4=Bo Kyoung |last5=Ryu |first5=Seungho |last6=Chang |first6=Yoosoo |last7=Yun |first7=Jihwan |last8=Jang |first8=Hyemin |last9=Kim |first9=Jun Pyo |last10=Kim |first10=Hee Jin |last11=Koh |first11=Seong-Beom |last12=Jeong |first12=Jee Hyang |last13=Na |first13=Duk L. |last14=Seo |first14=Sang Won |last15=Kang |first15=Sung Hoon |date=2024-08-29 |title=Different associations between body mass index and Alzheimer's markers depending on metabolic health |journal=Alzheimer's Research & Therapy |volume=16 |issue=1 |page=194 |doi=10.1186/s13195-024-01563-z |doi-access=free |issn=1758-9193 |pmc=11363444 |pmid=39210402}}</ref> There is also evidence of increased risk of developing Alzheimer's for those with a higher BMI in women ages 70 and above.<ref>{{Cite journal |last1=Gustafson |first1=Deborah |last2=Rothenberg |first2=Elisabet |last3=Blennow |first3=Kaj |last4=Steen |first4=Bertil |last5=Skoog |first5=Ingmar |date=2003-07-14 |title=An 18-Year Follow-up of Overweight and Risk of Alzheimer Disease |url=http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinte.163.13.1524 |journal=Archives of Internal Medicine |language=en |volume=163 |issue=13 |pages=1524–1528 |doi=10.1001/archinte.163.13.1524 |pmid=12860573 |issn=0003-9926|url-access=subscription }}</ref> While [[continuous positive airway pressure]] (CPAP) wasn't found to significantly improve cognitive performance, it was found to benefit other symptoms like depression, anxiety, etc.<ref>{{Cite journal |last1=Oliver |first1=Cerys |last2=Li |first2=Haoxuan |last3=Biswas |first3=Bijetri |last4=Woodstoke |first4=David |last5=Blackman |first5=Jonathan |last6=Butters |first6=Anneka |last7=Drew |first7=Cheney |last8=Gabb |first8=Victoria |last9=Harding |first9=Sam |last10=Hoyos |first10=Camilla M. |last11=Kendrick |first11=Adrian |last12=Rudd |first12=Sarah |last13=Turner |first13=Nicholas |last14=Coulthard |first14=Elizabeth |date=2024-02-01 |title=A systematic review on adherence to continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) in individuals with mild cognitive impairment and Alzheimer's disease dementia |journal=Sleep Medicine Reviews |volume=73 |article-number=101869 |doi=10.1016/j.smrv.2023.101869 |pmid=37924680 |issn=1087-0792|doi-access=free }}</ref>
 ==Diagnosis==
@@ Line 101: / Line 101: @@
 === Criteria ===
-According to the [[International Classification of Sleep Disorders]], there are 4 types of criteria.<ref>{{cite book | chapter-url=https://link.springer.com/chapter/10.1007/978-1-4939-6578-6_27 | doi=10.1007/978-1-4939-6578-6_27 | chapter=International Classification of Sleep Disorders | title=Sleep Disorders Medicine | date=2017 | pages=475–484 | isbn=978-1-4939-6576-2 | vauthors=Thorpy M | access-date=10 October 2024 | archive-date=11 May 2021 | archive-url=https://web.archive.org/web/20210511100659/https://link.springer.com/chapter/10.1007/978-1-4939-6578-6_27 | url-status=live }}</ref><ref name="aasm">{{Cite book |url=https://aasm.org/wp-content/uploads/2019/05/ICSD3-TOC.pdf |title=International Classification of Sleep Disorders, Third Edition|year=2014|publisher=American Academy of Sleep Medicine|location=Darien, IL|access-date=10 October 2024|isbn=978-0991543403}}{{page needed|date=September 2020}}</ref> The first one concerns sleep – [[Excessive daytime sleepiness|excessive sleepiness]], nonrestorative sleep, [[fatigue]] or [[insomnia]] symptoms. The second and third criteria are about [[Respiration (physiology)|respiration]] – waking with breath holding, gasping, or choking; snoring, breathing interruptions or both during sleep. The last criterion revolved around medical issues as hypertension, coronary artery disease, stroke, heart failure, atrial fibrillation, type 2 diabetes mellitus, [[mood disorder]] or [[cognitive impairment]]. Two levels of severity are distinguished, the first one is determined by a [[polysomnography]] or home sleep apnea test demonstrating 5 or more predominantly obstructive respiratory events per hour of sleep and the higher levels are determined by 15 or more events. If the events are present less than 5 times per hour, no obstructive sleep apnea is diagnosed.<ref name="aasm"/>
+According to the [[International Classification of Sleep Disorders]], there are 4 types of criteria.<ref>{{cite book | chapter-url=https://link.springer.com/chapter/10.1007/978-1-4939-6578-6_27 | doi=10.1007/978-1-4939-6578-6_27 | chapter=International Classification of Sleep Disorders | title=Sleep Disorders Medicine | date=2017 | pages=475–484 | isbn=978-1-4939-6576-2 | vauthors=Thorpy M | access-date=10 October 2024 | archive-date=11 May 2021 | archive-url=https://web.archive.org/web/20210511100659/https://link.springer.com/chapter/10.1007/978-1-4939-6578-6_27 | url-status=live }}</ref><ref name="aasm">{{Cite book |url=https://aasm.org/wp-content/uploads/2019/05/ICSD3-TOC.pdf |title=International Classification of Sleep Disorders, Third Edition|year=2014|publisher=American Academy of Sleep Medicine|location=Darien, IL|access-date=10 October 2024|isbn=978-0-9915434-0-3}}{{page needed|date=September 2020}}</ref> The first one concerns sleep – [[Excessive daytime sleepiness|excessive sleepiness]], [[non-restorative sleep]], [[fatigue]] or [[insomnia]] symptoms. The second and third criteria are about [[Respiration (physiology)|respiration]] – waking with breath holding, gasping, or choking; snoring, breathing interruptions or both during sleep. The last criterion revolved around medical issues as hypertension, coronary artery disease, stroke, heart failure, atrial fibrillation, type 2 diabetes mellitus, [[mood disorder]] or [[cognitive impairment]]. Two levels of severity are distinguished, the first one is determined by a [[polysomnography]] or home sleep apnea test demonstrating 5 or more predominantly obstructive respiratory events per hour of sleep and the higher levels are determined by 15 or more events. If the events are present less than 5 times per hour, no obstructive sleep apnea is diagnosed.<ref name="aasm"/>
 A considerable night-to-night variability further complicates diagnosis of OSA. In unclear cases, multiple nights of testing might be required to achieve an accurate diagnosis.<ref>{{Cite journal |last1=Tschopp |first1=Samuel |last2=Wimmer |first2=Wilhelm |last3=Caversaccio |first3=Marco |last4=Borner |first4=Urs |last5=Tschopp |first5=Kurt |date=2021-03-30 |title=Night-to-night variability in obstructive sleep apnea using peripheral arterial tonometry: a case for multiple night testing |journal=Journal of Clinical Sleep Medicine |language=en |volume=17 |issue=9 |pages=1751–1758 |doi=10.5664/jcsm.9300 |issn=1550-9389 |pmc=8636340|pmid=33783347 |s2cid=232420123}}</ref> Since sequential nights of testing would be impractical and cost prohibitive in the sleep lab, home sleep testing for multiple nights can not only be more useful, but more reflective of what is typically happening each night.<ref>{{cite journal |last1=Punjabi |first1=Naresh |title=Variability and Misclassification of Sleep Apnea Severity Based on Multi-Night Testing |journal=Chest Journal |date=18 February 2020 |volume=158 |issue=1 |pages=365–373 |doi=10.1016/j.chest.2020.01.039 |pmid=32081650 |pmc=7339240 }}</ref>
@@ Line 128: / Line 128: @@
 === Central sleep apnea ===
 {{Main|Central sleep apnea}}
-The diagnosis of CSA syndrome is made when the presence of at least 5 central apnea events occur per hour.<ref name="Roberts-2022">{{Cite journal |last1=Roberts |first1=Erin Grattan |last2=Raphelson |first2=Janna R. |last3=Orr |first3=Jeremy E. |last4=LaBuzetta |first4=Jamie Nicole |last5=Malhotra |first5=Atul |date=2022-07-01 |title=The Pathogenesis of Central and Complex Sleep Apnea |url=https://doi.org/10.1007/s11910-022-01199-2 |journal=Current Neurology and Neuroscience Reports |language=en |volume=22 |issue=7 |pages=405–412 |doi=10.1007/s11910-022-01199-2 |issn=1534-6293 |pmc=9239939 |pmid=35588042}}</ref> There are multiple mechanisms that drive the apnea events. In individuals with heart failure with Cheyne-Stokes respiration, the brain's respiratory control centers are imbalanced during sleep.<ref>{{cite journal |vauthors=Yumino D, Bradley TD |date=February 2008 |title=Central sleep apnea and Cheyne-Stokes respiration |journal=Proceedings of the American Thoracic Society |volume=5 |issue=2 |pages=226–36 |doi=10.1513/pats.200708-129MG |pmid=18250216}}</ref> This results in ventilatory instability, caused by chemoreceptors that are hyperresponsive to CO2 fluctuations in the blood, resulting in high respiratory drive that leads to apnea.<ref name="Roberts-2022" /> Another common mechanism that causes CSA is the loss of the brain's wakefulness drive to breathe.<ref name="Roberts-2022" />
+The diagnosis of CSA syndrome is made when the presence of at least 5 central apnea events occur per hour.<ref name="Roberts-2022">{{Cite journal |last1=Roberts |first1=Erin Grattan |last2=Raphelson |first2=Janna R. |last3=Orr |first3=Jeremy E. |last4=LaBuzetta |first4=Jamie Nicole |last5=Malhotra |first5=Atul |date=2022-07-01 |title=The Pathogenesis of Central and Complex Sleep Apnea |journal=Current Neurology and Neuroscience Reports |language=en |volume=22 |issue=7 |pages=405–412 |doi=10.1007/s11910-022-01199-2 |issn=1534-6293 |pmc=9239939 |pmid=35588042}}</ref> There are multiple mechanisms that drive the apnea events. In individuals with heart failure with Cheyne-Stokes respiration, the brain's respiratory control centers are imbalanced during sleep.<ref>{{cite journal |vauthors=Yumino D, Bradley TD |date=February 2008 |title=Central sleep apnea and Cheyne-Stokes respiration |journal=Proceedings of the American Thoracic Society |volume=5 |issue=2 |pages=226–36 |doi=10.1513/pats.200708-129MG |pmid=18250216}}</ref> This results in ventilatory instability, caused by chemoreceptors that are hyperresponsive to CO<sub>2</sub> fluctuations in the blood, resulting in high respiratory drive that leads to apnea.<ref name="Roberts-2022" /> Another common mechanism that causes CSA is the loss of the brain's wakefulness drive to breathe.<ref name="Roberts-2022" />
 [[File:CentralApnea.png|thumb|Screenshot of a PSG system showing a central apnea]]
 CSA is organized into 6 individual syndromes: Cheyne-Stokes respiration, Complex sleep apnea, Primary CSA, High altitude periodic breathing, CSA from medication, CSA from comorbidity.<ref name="Roberts-2022" /> Like in OSA, nocturnal polysomnography is the mainstay of diagnosis for CSA.<ref name="Badr-2019"/> The degree of respiratory effort, measured by esophageal pressure or displacement of the thoracic or abdominal cavity, is an important distinguishing factor between OSA and CSA.<ref name="Badr-2019"/>
@@ Line 136: / Line 136: @@
 ==Management==
-The treatment of obstructive sleep apnea is different than that of central sleep apnea. Treatment often starts with behavioral therapy and some people may be suggested to try a continuous positive airway pressure (CPAP) device. Many people are told to avoid alcohol, sleeping pills, and other sedatives, which can relax throat muscles, contributing to the collapse of the airway at night.<ref name=SleepApneaTreatments /> The evidence supporting one treatment option compared to another for a particular person is not clear.<ref name="pmid36278514">{{cite journal |last1=Pinto |first1=Ana Carolina Pereira Nunes |last2=Rocha |first2=Aline |last3=Drager |first3=Luciano F |last4=Lorenzi-Filho |first4=Geraldo |last5=Pachito |first5=Daniela V |date=24 October 2022 |editor-last=Cochrane Airways Group |title=Non-invasive positive pressure ventilation for central sleep apnoea in adults |url= |journal=Cochrane Database of Systematic Reviews |language=en |volume=2022 |issue=10 |pages=CD012889 |doi=10.1002/14651858.CD012889.pub2 |pmc=9590003 |pmid=36278514 }}</ref>
+The treatment of obstructive sleep apnea is different than that of central sleep apnea. Treatment often starts with behavioral therapy and some people may be suggested to try a continuous positive airway pressure (CPAP) device. Many people are told to avoid alcohol, sleeping pills, and other sedatives, which can relax throat muscles, contributing to the collapse of the airway at night.<ref name=SleepApneaTreatments /> The evidence supporting one treatment option compared to another for a particular person is not clear.<ref name="pmid36278514">{{cite journal |last1=Pinto |first1=Ana Carolina Pereira Nunes |last2=Rocha |first2=Aline |last3=Drager |first3=Luciano F |last4=Lorenzi-Filho |first4=Geraldo |last5=Pachito |first5=Daniela V |date=24 October 2022 |editor-last=Cochrane Airways Group |title=Non-invasive positive pressure ventilation for central sleep apnoea in adults |url= |journal=Cochrane Database of Systematic Reviews |language=en |volume=2022 |issue=10 |article-number=CD012889 |doi=10.1002/14651858.CD012889.pub2 |pmc=9590003 |pmid=36278514 }}</ref>
 === Changing sleep position ===
@@ Line 145: / Line 145: @@
 [[File:CPAP device on a nightstand.jpg|thumb|CPAP device on a nightstand]]
 {{see also|Continuous positive airway pressure}}
-For moderate to severe sleep apnea, the most common treatment is the use of a continuous positive airway pressure (CPAP) or automatic positive airway pressure (APAP) device.<ref name=SleepApneaTreatments>{{cite web |url=http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_Treatments.html |title=How Is Sleep Apnea Treated? |publisher=[[National Heart, Lung, and Blood Institute]] |url-status=live |archive-url=https://web.archive.org/web/20071013043521/http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_Treatments.html |archive-date=13 October 2007 }}</ref><ref name=2012review/> These splint the person's airway open during sleep by means of pressurized air. The person typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine.<ref name=SleepApneaTreatments/>
+For moderate to severe sleep apnea, the most common treatment is the use of a continuous positive airway pressure (CPAP) or automatic positive airway pressure (APAP) device.<ref name=SleepApneaTreatments>{{cite web |url=https://www.nhlbi.nih.gov/health/sleep-apnea |title=How Is Sleep Apnea Treated? |publisher=[[National Heart, Lung, and Blood Institute]] |url-status=live |archive-url=https://web.archive.org/web/20071013043521/http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_Treatments.html |archive-date=13 October 2007 }}</ref><ref name=2012review/> These splint the person's airway open during sleep by means of pressurized air. The person typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine.<ref name=SleepApneaTreatments/>
 Although CPAP therapy is effective in reducing apneas and less expensive than other treatments, some people find it uncomfortable. Some complain of feeling trapped, having chest discomfort, and skin or nose irritation. Other side effects may include dry mouth, dry nose, nosebleeds, sore lips and gums.<ref name=AHRQ2011/>
@@ Line 167: / Line 167: @@
 ====Nasal obstruction====
-Often, correction of the nasal passages needs to be performed in addition to correction of the [[oropharynx]] passage. [[Septoplasty]] and [[Nasal concha|turbinate]] surgery may improve the nasal airway,<ref>{{cite journal |last1=Sundaram |first1=Supriya |last2=Lim |first2=Jerome |last3=Lasserson |first3=Toby J |last4=Lasserson |first4=TJ |title=Surgery for obstructive sleep apnoea in adults |journal=Cochrane Database of Systematic Reviews |date=19 October 2005 |issue=4 |pages=CD001004 |doi=10.1002/14651858.CD001004.pub2 |pmid=16235277 }}</ref> but has been found to be ineffective at reducing respiratory arousals during sleep.<ref>{{cite journal |last1=Li |first1=Hsueh-Yu |last2=Wang |first2=Pa-Chun |last3=Chen |first3=Yu-Pin |last4=Lee |first4=Li-Ang |last5=Fang |first5=Tuan-Jen |last6=Lin |first6=Hsin-Ching |title=Critical Appraisal and Meta-Analysis of Nasal Surgery for Obstructive Sleep Apnea |journal=American Journal of Rhinology & Allergy |date=January 2011 |volume=25 |issue=1 |pages=45–49 |doi=10.2500/ajra.2011.25.3558 |pmid=21711978 |s2cid=35117004 }}</ref>
+Often, correction of the nasal passages needs to be performed in addition to correction of the [[oropharynx]] passage. [[Septoplasty]] and [[Nasal concha|turbinate]] surgery may improve the nasal airway,<ref>{{cite journal |last1=Sundaram |first1=Supriya |last2=Lim |first2=Jerome |last3=Lasserson |first3=Toby J |last4=Lasserson |first4=TJ |title=Surgery for obstructive sleep apnoea in adults |journal=Cochrane Database of Systematic Reviews |date=19 October 2005 |issue=4 |article-number=CD001004 |doi=10.1002/14651858.CD001004.pub2 |pmid=16235277 }}</ref> but has been found to be ineffective at reducing respiratory arousals during sleep.<ref>{{cite journal |last1=Li |first1=Hsueh-Yu |last2=Wang |first2=Pa-Chun |last3=Chen |first3=Yu-Pin |last4=Lee |first4=Li-Ang |last5=Fang |first5=Tuan-Jen |last6=Lin |first6=Hsin-Ching |title=Critical Appraisal and Meta-Analysis of Nasal Surgery for Obstructive Sleep Apnea |journal=American Journal of Rhinology & Allergy |date=January 2011 |volume=25 |issue=1 |pages=45–49 |doi=10.2500/ajra.2011.25.3558 |pmid=21711978 |s2cid=35117004 }}</ref>
 ====Pharyngeal obstruction====
@@ Line 182: / Line 182: @@
 ====Multi-level surgery====
-[[Maxillomandibular advancement]] is considered the most effective surgery for people with sleep apnea, because it increases the posterior airway space.<ref>{{cite journal | vauthors = Prinsell JR | title = Maxillomandibular advancement surgery for obstructive sleep apnea syndrome | journal = Journal of the American Dental Association | volume = 133 | issue = 11 | pages = 1489–97; quiz 1539–40 | date = November 2002 | pmid = 12462692 | doi = 10.14219/jada.archive.2002.0079 }}</ref> However, health professionals are often unsure as to who should be referred for surgery and when to do so: some factors in referral may include failed use of CPAP or device use; anatomy which favors rather than impedes surgery; or significant [[Craniofacial abnormality|craniofacial abnormalities]] which hinder device use.<ref name="auspre01">{{cite journal |author=MacKay, Stuart |title=Treatments for snoring in adults |journal=Australian Prescriber |volume=34 |issue=34 |pages=77–79 |date=June 2011 |doi=10.18773/austprescr.2011.048 |doi-broken-date=8 June 2025 |doi-access=free }}</ref>
+[[Maxillomandibular advancement]] is considered the most effective surgery for people with sleep apnea, because it increases the posterior airway space.<ref>{{cite journal | vauthors = Prinsell JR | title = Maxillomandibular advancement surgery for obstructive sleep apnea syndrome | journal = Journal of the American Dental Association | volume = 133 | issue = 11 | pages = 1489–97; quiz 1539–40 | date = November 2002 | pmid = 12462692 | doi = 10.14219/jada.archive.2002.0079 }}</ref> However, health professionals are often unsure as to who should be referred for surgery and when to do so: some factors in referral may include failed use of CPAP or device use; anatomy which favors rather than impedes surgery; or significant [[Craniofacial abnormality|craniofacial abnormalities]] which hinder device use.<ref name="auspre01">{{cite journal |author=MacKay, Stuart |title=Treatments for snoring in adults |journal=Australian Prescriber |volume=34 |issue=34 |pages=77–79 |date=June 2011 |doi=10.18773/austprescr.2011.048 |doi-broken-date=1 July 2025 |doi-access=free }}</ref>
 ====Potential complications====
@@ Line 189: / Line 189: @@
 Surgery on the mouth and throat, as well as dental surgery and procedures, can result in postoperative swelling of the lining of the mouth and other areas that affect the airway. Even when the surgical procedure is designed to improve the airway, such as [[tonsillectomy]] and [[adenoidectomy]] or tongue reduction, swelling may negate some of the effects in the immediate postoperative period. Once the swelling resolves and the palate becomes tightened by postoperative scarring, however, the full benefit of the surgery may be noticed.<ref name="Chang-2023" />
-A person with sleep apnea undergoing any medical treatment must make sure their doctor and [[Nurse anesthetist|anesthetist]] are informed about the sleep apnea. Alternative and emergency procedures may be necessary to maintain the airway of sleep apnea patients.<ref>{{cite web |url=http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_LivingWith.html |title=What is Sleep Apnea? |year=2012 |website=National Heart, Lung, and Blood Institute |publisher=National Institutes of Health |access-date=15 February 2013 |url-status=live |archive-url=https://web.archive.org/web/20110828030048/http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_LivingWith.html |archive-date=28 August 2011}}</ref>
+A person with sleep apnea undergoing any medical treatment must make sure their doctor and [[Nurse anesthetist|anesthetist]] are informed about the sleep apnea. Alternative and emergency procedures may be necessary to maintain the airway of sleep apnea patients.<ref>{{cite web |url=https://www.nhlbi.nih.gov/health/sleep-apnea |title=What is Sleep Apnea? |year=2012 |website=National Heart, Lung, and Blood Institute |publisher=National Institutes of Health |access-date=15 February 2013 |url-status=live |archive-url=https://web.archive.org/web/20110828030048/http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_LivingWith.html |archive-date=28 August 2011}}</ref>
 ===Other===
@@ Line 196: / Line 196: @@
 [[Diaphragm pacing]], which involves the rhythmic application of electrical impulses to the diaphragm, has been used to treat central sleep apnea.<ref name="BhimjiDia15">{{EMedicine|article|1970348|Diaphragm Pacing}}</ref><ref>{{cite journal | vauthors = Yun AJ, Lee PY, Doux JD | title = Negative pressure ventilation via diaphragmatic pacing: a potential gateway for treating systemic dysfunctions | journal = Expert Review of Medical Devices | volume = 4 | issue = 3 | pages = 315–9 | date = May 2007 | pmid = 17488226 | doi = 10.1586/17434440.4.3.315 | s2cid = 30419488 }}</ref>
-In April 2014, the U.S. Food and Drug Administration granted pre-market approval for use of an upper airway stimulation system in people who cannot use a continuous positive airway pressure device. The Inspire Upper Airway Stimulation system is a [[hypoglossal nerve stimulation]] implant that senses respiration and applies mild electrical stimulation during inspiration, which pushes the tongue slightly forward to open the airway.<ref name="FDAInspire14">{{cite web |url=https://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/recently-approveddevices/ucm398321.htm |title=Inspire Upper Airway Stimulation&nbsp;– P130008 |work=FDA.gov |publisher=Food and Drug Administration |date=11 January 2016 |access-date=9 March 2016 |url-status=dead |archive-url=https://web.archive.org/web/20160311075714/https://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/recently-approveddevices/ucm398321.htm |archive-date=11 March 2016 }}</ref>
+In April 2014, the U.S. Food and Drug Administration granted pre-market approval for use of an upper airway stimulation system in people who cannot use a continuous positive airway pressure device. The Inspire Upper Airway Stimulation system is a [[hypoglossal nerve stimulation]] implant that senses respiration and applies mild electrical stimulation during inspiration, which pushes the tongue slightly forward to open the airway.<ref name="FDAInspire14">{{cite web |url=https://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/recently-approveddevices/ucm398321.htm |title=Inspire Upper Airway Stimulation&nbsp;– P130008 |work=FDA.gov |publisher=Food and Drug Administration |date=11 January 2016 |access-date=9 March 2016 |archive-url=https://web.archive.org/web/20160311075714/https://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/recently-approveddevices/ucm398321.htm |archive-date=11 March 2016 }}</ref>
 ====Medications====
-There is currently insufficient evidence to recommend any medication for OSA.<ref name="Efficacy of pharmacotherapy for OSA">{{cite journal |last1=Gaisl |first1=Thomas |last2=Haile |first2=Sarah R. |last3=Thiel |first3=Sira |last4=Osswald |first4=Martin |last5=Kohler |first5=Malcolm |title=Efficacy of pharmacotherapy for OSA in adults: A systematic review and network meta-analysis |journal=Sleep Medicine Reviews |date=August 2019 |volume=46 |pages=74–86 |doi=10.1016/j.smrv.2019.04.009 |pmid=31075665 |s2cid=149455430 }}</ref> This may result in part because people with sleep apnea have tended to be treated as a single group in clinical trials. Identifying specific physiological factors underlying sleep apnea makes it possible to test drugs specific to those causal factors: airway narrowing, impaired muscle activity, low arousal threshold for waking, and unstable breathing control.<ref name="Dolgin">{{cite journal |last1=Dolgin |first1=Elie |date=29 April 2020 |title=Treating sleep apnea with pills instead of machines |url=https://knowablemagazine.org/article/health-disease/2020/treating-sleep-apnea-pills-instead-machines |url-status=live |journal=Knowable Magazine |doi=10.1146/knowable-042820-1 |archive-url=https://web.archive.org/web/20220530121424/https://knowablemagazine.org/article/health-disease/2020/treating-sleep-apnea-pills-instead-machines |archive-date=30 May 2022 |access-date=9 May 2022 |doi-access=free}}</ref><ref name="Wellman">{{cite journal |last1=Wellman |first1=Andrew |last2=Eckert |first2=Danny J. |last3=Jordan |first3=Amy S. |last4=Edwards |first4=Bradley A. |last5=Passaglia |first5=Chris L. |last6=Jackson |first6=Andrew C. |last7=Gautam |first7=Shiva |last8=Owens |first8=Robert L. |last9=Malhotra |first9=Atul |last10=White |first10=David P. |title=A method for measuring and modeling the physiological traits causing obstructive sleep apnea |journal=Journal of Applied Physiology |date=June 2011 |volume=110 |issue=6 |pages=1627–1637 |doi=10.1152/japplphysiol.00972.2010 |pmid=21436459 |pmc=3119134 }}</ref> Those who experience low waking thresholds may benefit from [[eszopiclone]], a sedative typically used to treat insomnia.<ref name="Dolgin"/><ref>{{cite journal |last1=Eckert |first1=Danny J. |last2=Owens |first2=Robert L. |last3=Kehlmann |first3=Geoffrey B. |last4=Wellman |first4=Andrew |last5=Rahangdale |first5=Shilpa |last6=Yim-Yeh |first6=Susie |last7=White |first7=David P. |last8=Malhotra |first8=Atul |title=Eszopiclone increases the respiratory arousal threshold and lowers the apnoea/hypopnoea index in obstructive sleep apnoea patients with a low arousal threshold |journal=Clinical Science |date=7 March 2011 |volume=120 |issue=12 |pages=505–514 |doi=10.1042/CS20100588 |pmid=21269278 |pmc=3415379 |url=https://doi.org/10.1042/CS20100588 |access-date=10 May 2022 |issn=0143-5221 |archive-date=8 March 2024 |archive-url=https://web.archive.org/web/20240308031502/https://portlandpress.com/clinsci/article-abstract/120/12/505/68829/Eszopiclone-increases-the-respiratory-arousal?redirectedFrom=fulltext |url-status=live }}</ref> The antidepressant [[desipramine]] may stimulate upper airway muscles and lessen pharyngeal collapsibility in people who have limited muscle function in their airways.<ref name="Dolgin"/><ref>{{cite journal |last1=Taranto-Montemurro |first1=Luigi |last2=Sands |first2=Scott A. |last3=Edwards |first3=Bradley A. |last4=Azarbarzin |first4=Ali |last5=Marques |first5=Melania |last6=Melo |first6=Camila de |last7=Eckert |first7=Danny J. |last8=White |first8=David P. |last9=Wellman |first9=Andrew |title=Desipramine improves upper airway collapsibility and reduces OSA severity in patients with minimal muscle compensation |journal=European Respiratory Journal |date=1 November 2016 |volume=48 |issue=5 |pages=1340–1350 |doi=10.1183/13993003.00823-2016 |pmid=27799387 |pmc=5437721 |url=https://erj.ersjournals.com/content/48/5/1340 |access-date=10 May 2022 |language=en |issn=0903-1936 |archive-date=8 August 2022 |archive-url=https://web.archive.org/web/20220808100210/https://erj.ersjournals.com/content/48/5/1340 |url-status=live }}</ref>
+{{See also|List of investigational sleep apnea drugs}}
+There is currently insufficient evidence to recommend any medication for OSA.<ref name="Efficacy of pharmacotherapy for OSA">{{cite journal |last1=Gaisl |first1=Thomas |last2=Haile |first2=Sarah R. |last3=Thiel |first3=Sira |last4=Osswald |first4=Martin |last5=Kohler |first5=Malcolm |title=Efficacy of pharmacotherapy for OSA in adults: A systematic review and network meta-analysis |journal=Sleep Medicine Reviews |date=August 2019 |volume=46 |pages=74–86 |doi=10.1016/j.smrv.2019.04.009 |pmid=31075665 |s2cid=149455430 }}</ref> This may result in part because people with sleep apnea have tended to be treated as a single group in clinical trials. Identifying specific physiological factors underlying sleep apnea makes it possible to test drugs specific to those causal factors: airway narrowing, impaired muscle activity, low arousal threshold for waking, and unstable breathing control.<ref name="Dolgin">{{cite journal |last1=Dolgin |first1=Elie |date=29 April 2020 |title=Treating sleep apnea with pills instead of machines |url=https://knowablemagazine.org/article/health-disease/2020/treating-sleep-apnea-pills-instead-machines |url-status=live |journal=Knowable Magazine |doi=10.1146/knowable-042820-1 |archive-url=https://web.archive.org/web/20220530121424/https://knowablemagazine.org/article/health-disease/2020/treating-sleep-apnea-pills-instead-machines |archive-date=30 May 2022 |access-date=9 May 2022 |doi-access=free}}</ref><ref name="Wellman">{{cite journal |last1=Wellman |first1=Andrew |last2=Eckert |first2=Danny J. |last3=Jordan |first3=Amy S. |last4=Edwards |first4=Bradley A. |last5=Passaglia |first5=Chris L. |last6=Jackson |first6=Andrew C. |last7=Gautam |first7=Shiva |last8=Owens |first8=Robert L. |last9=Malhotra |first9=Atul |last10=White |first10=David P. |title=A method for measuring and modeling the physiological traits causing obstructive sleep apnea |journal=Journal of Applied Physiology |date=June 2011 |volume=110 |issue=6 |pages=1627–1637 |doi=10.1152/japplphysiol.00972.2010 |pmid=21436459 |pmc=3119134 }}</ref> Those who experience low waking thresholds may benefit from [[eszopiclone]], a sedative typically used to treat insomnia.<ref name="Dolgin"/><ref>{{cite journal |last1=Eckert |first1=Danny J. |last2=Owens |first2=Robert L. |last3=Kehlmann |first3=Geoffrey B. |last4=Wellman |first4=Andrew |last5=Rahangdale |first5=Shilpa |last6=Yim-Yeh |first6=Susie |last7=White |first7=David P. |last8=Malhotra |first8=Atul |title=Eszopiclone increases the respiratory arousal threshold and lowers the apnoea/hypopnoea index in obstructive sleep apnoea patients with a low arousal threshold |journal=Clinical Science |date=7 March 2011 |volume=120 |issue=12 |pages=505–514 |doi=10.1042/CS20100588 |pmid=21269278 |pmc=3415379 |issn=0143-5221 }}</ref> The antidepressant [[desipramine]] may stimulate upper airway muscles and lessen pharyngeal collapsibility in people who have limited muscle function in their airways.<ref name="Dolgin"/><ref>{{cite journal |last1=Taranto-Montemurro |first1=Luigi |last2=Sands |first2=Scott A. |last3=Edwards |first3=Bradley A. |last4=Azarbarzin |first4=Ali |last5=Marques |first5=Melania |last6=Melo |first6=Camila de |last7=Eckert |first7=Danny J. |last8=White |first8=David P. |last9=Wellman |first9=Andrew |title=Desipramine improves upper airway collapsibility and reduces OSA severity in patients with minimal muscle compensation |journal=European Respiratory Journal |date=1 November 2016 |volume=48 |issue=5 |pages=1340–1350 |doi=10.1183/13993003.00823-2016 |pmid=27799387 |pmc=5437721 |url=https://erj.ersjournals.com/content/48/5/1340 |access-date=10 May 2022 |language=en |issn=0903-1936 |archive-date=8 August 2022 |archive-url=https://web.archive.org/web/20220808100210/https://erj.ersjournals.com/content/48/5/1340 |url-status=live }}</ref>
 There is limited evidence for medication, but 2012 AASM guidelines suggested that [[acetazolamide]] "may be considered" for the treatment of central sleep apnea; [[zolpidem]] and [[triazolam]] may also be considered for the treatment of central sleep apnea,<ref name="Lambert">{{cite journal |last1=Lambert |first1=Mara |title=Updated Guidelines from AASM for the Treatment of Central Sleep Apnea Syndromes |journal=American Family Physician |date=15 November 2012 |volume=86 |issue=10 |pages=968–971 |url=https://www.aafp.org/afp/2012/1115/p968.html |access-date=10 May 2022 |issn=0002-838X |archive-date=10 May 2022 |archive-url=https://web.archive.org/web/20220510120148/https://www.aafp.org/afp/2012/1115/p968.html |url-status=live }}</ref> but "only if the patient does not have underlying risk factors for respiratory depression".<ref name="Efficacy of pharmacotherapy for OSA"/><ref name=2012review>{{cite journal | vauthors = Aurora RN, Chowdhuri S, Ramar K, Bista SR, Casey KR, Lamm CI, Kristo DA, Mallea JM, Rowley JA, Zak RS, Tracy SL | title = The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses | journal = Sleep | volume = 35 | issue = 1 | pages = 17–40 | date = January 2012 | pmid = 22215916 | pmc = 3242685 | doi = 10.5665/sleep.1580 }}</ref> Low doses of oxygen are also used as a treatment for [[Hypoxia (medicine)|hypoxia]] but are discouraged due to side effects.<ref name=PsychToday>{{cite web |url=http://www.psychologytoday.com/conditions/sleep-apnea |title=Sleep Apnea |work=Diagnosis Dictionary |publisher=[[Psychology Today]] |url-status=live |archive-url=https://archive.today/20130408080751/http://www.psychologytoday.com/conditions/sleep-apnea |archive-date=8 April 2013 }}</ref><ref name="pmid11181239">{{cite journal |last1=Mayos |first1=M. |last2=Hernández Plaza |first2=L. |last3=Farré |first3=A. |last4=Mota |first4=S. |last5=Sanchis |first5=J. |title=Efecto de la oxigenoterapia nocturna en el paciente con síndrome de apnea-hipopnea del sueño y limitación crónica al flujo aéreo |trans-title=The effect of nocturnal oxygen therapy in patients with sleep apnea syndrome and chronic airflow limitation |language=es |journal=Archivos de Bronconeumología |date=January 2001 |volume=37 |issue=2 |pages=65–68 |doi=10.1016/s0300-2896(01)75016-8 |pmid=11181239 }}</ref><ref name="pmid2609134">{{cite journal | vauthors = Breitenbücher A, Keller-Wossidlo H, Keller R | title = Transtracheale Sauerstofftherapie beim obstruktiven Schlafapnoe-Syndrom |trans-title=Transtracheal oxygen therapy in obstructive sleep apnea syndrome | language = de | journal = Schweizerische Medizinische Wochenschrift | volume = 119 | issue = 46 | pages = 1638–1641 | date = November 1989 | pmid = 2609134 |oclc=119157195 }}</ref>
-In December 2024, the FDA approved [[tirzepatide]], an anti-diabetic and weight loss medication, as a component in the combination treatment of adults with obesity suffering from moderate to severe obstructive sleep apnea. Other components of the therapy are a reduced-calorie diet and increased physical activity.<ref>{{Cite web |last=Commissioner |first=Office of the |date=2024-12-20 |title=FDA Approves First Medication for Obstructive Sleep Apnea |url=https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea |archive-url=https://web.archive.org/web/20241220234436/https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea |url-status=dead |archive-date=20 December 2024 |access-date=2024-12-25 |website=FDA |language=en}}</ref>
+In December 2024, the FDA approved [[tirzepatide]], an anti-diabetic and weight loss medication, as a component in the combination treatment of adults with obesity suffering from moderate to severe obstructive sleep apnea. Other components of the therapy are a reduced-calorie diet and increased physical activity.<ref>{{Cite web |last=Commissioner |first=Office of the |date=2024-12-20 |title=FDA Approves First Medication for Obstructive Sleep Apnea |url=https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea |archive-url=https://web.archive.org/web/20241220234436/https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea |archive-date=20 December 2024 |access-date=2024-12-25 |website=FDA |language=en}}</ref>
 ====Oral appliances====
@@ Line 209: / Line 211: @@
 ====Nasal EPAP====
-[[Nasal EPAP]] is a bandage-like device placed over the nostrils that uses a person's own breathing to create positive airway pressure to prevent obstructed breathing.<ref name=Riaz2015rev>{{cite journal | vauthors = Riaz M, Certal V, Nigam G, Abdullatif J, Zaghi S, Kushida CA, Camacho M | title = Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis | journal = Sleep Disorders | volume = 2015 | pages = 734798 | date = 2015 | pmid = 26798519 | pmc = 4699057 | doi = 10.1155/2015/734798 | doi-access = free }}</ref>
+[[Nasal EPAP]] is a bandage-like device placed over the nostrils that uses a person's own breathing to create positive airway pressure to prevent obstructed breathing.<ref name=Riaz2015rev>{{cite journal | vauthors = Riaz M, Certal V, Nigam G, Abdullatif J, Zaghi S, Kushida CA, Camacho M | title = Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis | journal = Sleep Disorders | volume = 2015 | article-number = 734798 | date = 2015 | pmid = 26798519 | pmc = 4699057 | doi = 10.1155/2015/734798 | doi-access = free }}</ref>
 ====Oral pressure therapy====
@@ Line 215: / Line 217: @@
 ==Prognosis==
-Death could occur from untreated OSA due to lack of oxygen to the body.<ref name=AHRQ2011>{{cite web|url=https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=731|title=Diagnosis and Treatment of Obstructive Sleep Apnea in Adults|publisher=AHRQ Effective Health Care Program|date=8 August 2011|url-status=dead|archive-url=https://web.archive.org/web/20161231230122/https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=731|archive-date=31 December 2016}}. A [https://www.effectivehealthcare.ahrq.gov/ehc/products/117/1534/sleep-apnea-surveillance-130502.pdf 2012 surveillance update] {{webarchive|url=https://web.archive.org/web/20170125113854/http://www.effectivehealthcare.ahrq.gov/ehc/products/117/1534/sleep-apnea-surveillance-130502.pdf |date=25 January 2017 }} found no significant information to update.</ref>
+Death could occur from untreated OSA due to lack of oxygen to the body.<ref name=AHRQ2011>{{cite web|url=https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=731|title=Diagnosis and Treatment of Obstructive Sleep Apnea in Adults|publisher=AHRQ Effective Health Care Program|date=8 August 2011|archive-url=https://web.archive.org/web/20161231230122/https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=731|archive-date=31 December 2016}}. A [https://www.effectivehealthcare.ahrq.gov/ehc/products/117/1534/sleep-apnea-surveillance-130502.pdf 2012 surveillance update] {{webarchive|url=https://web.archive.org/web/20170125113854/http://www.effectivehealthcare.ahrq.gov/ehc/products/117/1534/sleep-apnea-surveillance-130502.pdf |date=25 January 2017 }} found no significant information to update.</ref>
 There is increasing evidence that sleep apnea may lead to liver function impairment, particularly [[fatty liver]] diseases (see [[steatosis]]).<ref name="aloiaetal">{{cite journal | vauthors = Aloia MS, Sweet LH, Jerskey BA, Zimmerman M, Arnedt JT, Millman RP | title = Treatment effects on brain activity during a working memory task in obstructive sleep apnea | journal = Journal of Sleep Research | volume = 18 | issue = 4 | pages = 404–10 | date = December 2009 | pmid = 19765205 | doi = 10.1111/j.1365-2869.2009.00755.x | hdl = 2027.42/73986 | s2cid = 15806274 |hdl-access=free }}</ref><ref name="apnea">{{cite journal | vauthors = Ahmed MH, Byrne CD | title = Obstructive sleep apnea syndrome and fatty liver: association or causal link? | journal = World Journal of Gastroenterology | volume = 16 | issue = 34 | pages = 4243–52 | date = September 2010 | pmid = 20818807 | pmc = 2937104 | doi = 10.3748/wjg.v16.i34.4243 | doi-access = free }}</ref><ref name="apnea2">{{cite journal | vauthors = Singh H, Pollock R, Uhanova J, Kryger M, Hawkins K, Minuk GY | title = Symptoms of obstructive sleep apnea in patients with nonalcoholic fatty liver disease | journal = Digestive Diseases and Sciences | volume = 50 | issue = 12 | pages = 2338–43 | date = December 2005 | pmid = 16416185 | doi = 10.1007/s10620-005-3058-y | s2cid = 21852391 }}</ref><ref name="apnea3">{{cite journal | vauthors = Tanné F, Gagnadoux F, Chazouillères O, Fleury B, Wendum D, Lasnier E, Lebeau B, Poupon R, Serfaty L | title = Chronic liver injury during obstructive sleep apnea | journal = Hepatology | volume = 41 | issue = 6 | pages = 1290–6 | date = June 2005 | pmid = 15915459 | doi = 10.1002/hep.20725 | doi-access = free }}</ref>
@@ Line 269: / Line 271: @@
 | MeshID           = D012891
 }}
-{{Sleep}}
+{{Sleep}}{{Respiratory system symptoms and signs}}{{Authority control}}
-{{Authority control}}
 {{DEFAULTSORT:Sleep Apnea}}

Sleep apnea: Difference between revisions

Latest revision as of 21:12, 5 November 2025

Contents

Signs and symptoms

Risk factors

Mechanism

Complications

Diagnosis

Classification

Obstructive sleep apnea

Criteria

Polysomnography

Central sleep apnea

Mixed apnea

Management

Changing sleep position

Continuous positive airway pressure

Weight loss

Rapid palatal expansion

Surgery

Nasal obstruction

Pharyngeal obstruction

Hypopharyngeal or base of tongue obstruction

Multi-level surgery

Potential complications

Other

Neurostimulation

Medications

Oral appliances

Nasal EPAP

Oral pressure therapy

Prognosis

Epidemiology

Frequency and population

History

Treatment

See also

References

Navigation menu

Sleep apnea: Difference between revisions

Latest revision as of 21:12, 5 November 2025

Signs and symptoms

Risk factors

Mechanism

Complications

Diagnosis

Classification

Obstructive sleep apnea

Criteria

Polysomnography

Central sleep apnea

Mixed apnea

Management

Changing sleep position

Continuous positive airway pressure

Weight loss

Rapid palatal expansion

Surgery

Nasal obstruction

Pharyngeal obstruction

Hypopharyngeal or base of tongue obstruction

Multi-level surgery

Potential complications

Other

Neurostimulation

Medications

Oral appliances

Nasal EPAP

Oral pressure therapy

Prognosis

Epidemiology

Frequency and population

History

Treatment

See also

References

Navigation menu

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