SLEEP-DISORDERED BREATHING DIAGNOSIS AND TREATMENTkapak

DIAGNOSIS AND TREATMENT ALGORITHM IN OBSTRUCTIVE SLEEP APNEA

Zehra Betül Paksoy

Ankara Bilkent City Hospital, Department of Otorhinolaryngology, Ankara, Türkiye

Paksoy ZB. Diagnosis and Treatment Algorithm in Obstructive Sleep Apnea. In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.99-110.

ABSTRACT

Obstructive sleep apnea (OSA) is a condition characterized by recurrent upper airway obstruction during sleep, leading to decreased quality of life and increased cardiovascular risks. Sleep tests are needed to make a definitive diagnosis of the disease. Standard polysomnography, performed overnight in a sleep laboratory under the supervision of a sleep technician, is the gold standard for diagnosis. Diagnosis can also be made through out of center sleep testing in individuals suspected of moderate to severe OSA, but without serious comorbidities, following a detailed evaluation by a certified sleep physician. Patients with obstructive respiratory events of 15 or more per hour as a result of the sleep test are diagnosed with OSA. OSA is diagnosed if the obstructive respiratory events occur at 5 or more per hour and the patient experiences complaints such as nocturnal awakenings due to pauses in breathing, excessive daytime sleepiness, unrefreshing sleep, and fatigue that causes deterioration in sleep-related quality of life. The severity of the condition is determined by the apnea-hypopnea index. An apnea-hypopnea index between 5 and 15 is considered mild; 15-30 is moderate; and 30 and above is severe. Treatment decisions for OSA are based on the diagnosis made based on the sleep test and the severity of the condition. In addition, other factors that influence the treatment decision are the patient’s age, weight and body mass index, the presence of an anatomical disorder causing narrowing in the upper airway, the depth of desaturations in the sleep test and the time the saturation is below 90%, and the presence of serious comorbid diseases. Treatment options include Continuous positive airway pressure (CPAP), oral appliances, hypoglossal nerve stimulation (HNS), radiofrequency ablation (RFA), and surgical interventions. Although CPAP is considered the gold standard therapy, long-term adherence challenges have underscored the importance of surgical and minimally invasive treatments. Multilevel surgeries aim to simultaneously address obstructions at multiple anatomical levels of the airway, thereby enhancing surgical success rates. HNS has emerged as an effective alternative, particularly in patients noncompliant with CPAP, while RFA offers a minimally invasive option with low morbidity rates. Patient adherence to treatment and education on lifestyle modifications are fundamental components that determine therapeutic success. Therefore, a multidisciplinary approach should be adopted in the management of OSAS, with a focus on long-term follow-up and monitoring.

Keywords: Obstructive sleep apnea (OSAS); Continuous positive airway pressure (CPAP); Treatment adherence and compliance; Radiofrequency ablation (RFA); Mandibular advancement devices (MAD); Hypoglossal nerve

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