Adult Obstructive Sleep Apnea/Hypopnea Syndrome: Definitions, Risk Factors, and Pathogenesis

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Definitions

The International Classification of Sleep Disorders, Second Edition (ICSD-2) classifies sleep-related breathing disorders into 3 basic categories: central sleep apnea syndrome, obstructive sleep apnea (OSA) syndrome, and sleep-related hypoventilation/hypoxic syndrome. In this classification, the term “upper airway resistance syndrome” is subsumed under the diagnosis of OSA because the pathophysiology is so similar to that of OSA. Sleep apnea is termed “obstructive” when respiratory effort is

Prevalence

According to the first major US population-based study conducted about 15 years ago, when AHI criteria based on thermistor measures of airflow are applied to a general population of middle-aged adults, 24% of men and 9% of women meet criteria for OSA.8 These prevalence figures are based on a cutoff AHI of 5 or higher. Most of these patients (>50%) had mild sleep apnea according to current criteria. If the symptom of sleepiness is included as part of a syndromic definition (OSA syndrome), 4% of

Pathogenesis

The upper airway in humans has a complex anatomic structure characterized by an elongated posterior pharyngeal space, a 90 degree bend in airflow, and lack of rigidity. This is in part due to its multipurpose function of phonation, swallowing, and breathing. With respect to breathing and the underlying pathogenesis of sleep apnea, the patency of the upper airway depends on a balance of forces: forces that promote airway collapse and opposing forces that maintain upper airway patency. Forces

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