Obstructive Sleep Apnea: Strategies for Screening, Management, and Overcoming Treatment Challenges in the Outpatient Setting

Abstract

Obstructive sleep apnea (OSA) is characterized by repetitive airway closure, which can lead to hypoxemia and sympathetic nervous system activation. This can result in significant cardiovascular and neurologic morbidity. Therefore, early recognition and treatment are extremely important. The gold standard treatment of OSA is positive airway pressure, which has been shown to decrease the risk of these sequelae. Alternatives to positive airway pressure therapy are not commonly discussed but are available to those who are not able to tolerate positive airway pressure. The goal of this review is to discuss the pathophysiology, epidemiology, screening and testing, and treatment considerations for OSA.

Keywords: Berlin; STOP-BANG; hypoglossal nerve stimulator; obstructive sleep apnea; positive airway pressure; uvulopalatopharyngoplasty.

Figure 1.

Depiction of the hypoglossal nerve stimulator. From [Strollo Jr PJ et al. Upper Airway Stimulation for Obstructive Sleep Apnea. 9;370(2):139-49. Copyright © 2014 Massachusetts Medical Society. Reprinted with permission.

Figure 2.

Example of an EPAP nasal device. Inhalation (A) with the contracted flexible shell (yellow), and exhalation (B) with the expanded flexible shell (yellow). Airflow direction is indicated with red arrows. Adapted with permission from authors [Sleeper et al. Sleep Med 2022;96:87-92]