Sleep Apnea (OSA)

•RCT evidence— CPAP for symptoms strong; CV outcomes more nuanced

Why it matters

OSA fragments sleep, repeatedly drops oxygen saturation, and produces sympathetic surges that drive:

• 2–3× cardiovascular event and mortality risk.
• Resistant hypertension.
• Atrial fibrillation.
• Type-2 diabetes.
• Cognitive decline, dementia.
• Daytime sleepiness, motor-vehicle crashes.
• Mood disturbance.
• Reduced quality of life.

Who to screen

Many adults have OSA and don’t know it. Screen if:

• Habitual snoring, witnessed apneas, gasping arousals.
• Excessive daytime sleepiness (Epworth Sleepiness Scale >10).
• Resistant hypertension or atrial fibrillation.
• Treatment-resistant heart failure.
• BMI >30.
• Large neck circumference (>43 cm men, >41 cm women).
• Stroke or TIA.

Diagnosis

• In-laboratory polysomnography: gold standard.
• Home Sleep Apnea Test (HSAT): cheaper, reasonable for high-pretest- probability uncomplicated cases.

Treatment

• CPAP: gold standard for moderate-severe OSA. Reliably normalises AHI and symptoms when used >4 h/night.
• Mandibular advancement devices: for mild-moderate or CPAP-intolerant.
• Weight loss: 10% body weight loss often halves AHI.
• Positional therapy in supine-dominant OSA.
• Tirzepatide (SURMOUNT-OSA 2024): substantial AHI reduction in obese OSA, with implications for OSA management as a metabolic disease.
• Hypoglossal nerve stimulation (Inspire) for selected patients intolerant to CPAP.

Related entries

AHI, Hypertension, Atrial fibrillation, GLP-1 agonists.