Obstructive Sleep Apnea (OSA)

Obstructive Sleep Apnea (OSA) is a sleep disorder characterized by the narrowing of the upper airway, resulting in snoring or sleep apnea depending on the severity of the obstruction. Patients with OSA often experience excessive daytime sleepiness despite feeling that they have had adequate sleep. Additionally, they may suffer from reduced concentration, memory impairment, diminished daily function, and decreased work performance. Furthermore, OSA can increase the risk or severity of complications in other organ systems, such as hypertension, myocardial infarction, cardiac arrhythmias, heart failure, and stroke. (1)

The prevalence of OSA in the Thai population is as high as 60.5% in males and 25.1% in females. (2) Due to its high severity and prevalence, OSA is considered a significant public health and social issue in Thailand.

OSA can be diagnosed using a polysomnogram (PSG), a sleep study designed to identify sleep abnormalities. Diagnostic criteria require the detection of at least 5 respiratory events per hour of sleep, which may manifest as apnea, hypopnea, or other breathing abnormalities. (3)

The PSG results are used to calculate the Apnea-Hypopnea Index (AHI) and the Respiratory Disturbance Index (RDI), derived from the average number of abnormal respiratory events per hour of sleep. (4) The severity of OSA is categorized as mild with 5–15 events per hour, moderate with 15–30 events per hour, and severe with 30 or more events per hour. (3)

Research shows that most adult patients with OSA present with anatomical narrowing at multiple upper airway levels, including the soft palate (velum), oropharynx, tongue base, and epiglottis. (5) Other risk factors include nasal obstruction caused by allergic rhinitis, sinusitis, rhinitis, and/or a deviated nasal septum. (6) The gold standard treatment for patients with moderate to severe OSA is Continuous Positive Airway Pressure (CPAP) therapy. For patients with mild OSA, lifestyle modifications and surgical options to expand the airway are recommended. (7-10)

อ้างอิง

1. Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021; 144(3): 56-67.

2. Tawaranurak K, Leelasawatsuk P, Chaiyarukjirakun V. Prevalence, risk factors and clinical manifestation of patients suspected as having obstructive sleep apnea in songklanagarind hospital sleep center. J Health Sci Med Res. 2019; 37(4): 8.

3. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: An American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017; 13(3): 479-504.

4. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J, Jr., et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005; 28(4): 499-521.

5. Bacak B, Porterfield L, Karelsky S. Multilevel airway obstruction phenotypes in adult OSA. OTO Open. 2023; 7(2): 21.

6. Young T, Finn L, Kim H. Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group. J Allergy Clin Immunol. 1997; 99(2): 757-62.

7. Supiyaphan MDP, Sonsuwan MDN, Neruntarat MDC, Mahakit MDP, Keskool MDP, Banhiran MDW, et al. Guideline for development of diagnosis and treatment of snoring and obstructive sleep apnea in thailand for adults 2025. Thai Journal of Otolaryngology Head and Neck Surgery. 2025; 25(2).

8. Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P. Management of obstructive sleep apnea in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013; 159(7): 471-83.

9. Rajesh S, Wonderling D, Simonds AK. Obstructive sleep apnoea/hypopnoea syndrome and obesity hyperventilation syndrome in over 16s: summary of NICE guidance. Bmj. 2021; 375: 2360.

10. Nirantranat C MP, Banhiran W,. Guideline for development of diagnosis and treatment of snoring and obstructive sleep apnea in thailand for adults 2017. The Sleep Apnea Society of Thailand. 2017: 1-40.

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