OBSTRUCTIVE SLEEP-APNEA TRENDS IN THERAPY

The National Commission on Sleep Disorders Research, in its report to Congress, concluded that the primary care community generally does not understand sleep disorders. Obstructive sleep apnea carries a risk of substantial morbidity and mortality. Excessive daytime sleepiness res ults from fragmented sleep and microarousals associated with apneic ev ents. It causes poor work performance and increases the incidence of a utomobile accidents due to driving while drowsy. The commission estima tes that the loss of productivity in the United States from excessive daytime sleepiness is more than $20 billion per year. Obstructive slee p apnea is strongly associated with hypertension, myocardial infarctio n, and stroke. Risk factors for obstructive sleep apnea include male s ex, obesity, older age, craniofacial anomalies, and familial risk. Tre atment is based on documenting the disorder by polysomnography. Medica l management of the syndrome includes weight loss and nasal continuous positive airway pressure. A network of follow-up and support is neces sary to maintain compliance. Surgical treatment is reserved for those for whom nasal airway pressure treatment fails. A surgical protocol is presented that demonstrates efficacy equal to nasal airway pressure t reatment. Primary care physicians should assume the responsibility of identifying patients at risk for obstructive sleep apnea and refer the m appropriately.