Sleep Apnea in Turkey: Symptoms, Causes & Treatment | aihealz
PulmonologysevereICD-10 · G47.30
Sleep Apnea.Care & specialists in Turkey
In Turkey, sleep Apnea is managed by pulmonologists. Sleep apnea is a breathing disorder in which the airway repeatedly closes or the brain briefly stops signaling breaths during sleep, fragmenting rest and dropping oxygen levels dozens to hundreds of times each night. The obstructive form (OSA) affects an estimated 936 million adults aged 30-69 worldwide, with 425 million in the moderate-to-severe range (Benjafield 2019).
aliases · Sleep Apnea (Obstructive and Central)· निद्रा श्वासावरोध (Nidra shvasavarodh)· Apnée du sommeil· Apnea del sueño· reviewed May 12, 2026
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Reviewed by AIHealz Medical Editorial Board · PulmonologyLast reviewed May 12, 2026
Sleep apnea (ICD-10: G47.33 obstructive sleep apnea, adult pediatric; G47.31 central sleep apnea) is a sleep-related breathing disorder defined by repetitive complete (apnea) or partial (hypopnea) reductions in airflow during sleep, each lasting at least 10 seconds and typically ending in a brief cortical arousal or oxygen desaturation of 3% or more. Severity is quantified by the apnea-hypopnea index (AHI), the number of these events per hour of sleep: mild 5-15, moderate 15-30, severe >30 by AASM 2017 scoring criteria. Obstructive sleep apnea (OSA) accounts for over 90% of cases and results from collapse of the upper airway at the level of the soft palate, tongue base, or lateral pharyngeal walls when pharyngeal dilator muscle tone falls during sleep. Central sleep apnea (CSA, G47.31) is far less common and reflects a transient loss of respiratory drive from the brainstem, often in the context of heart failure, opioid use, high-altitude exposure, or stroke.
key facts
Prevalence
~26% of US adults aged 30-70 have at least mild OSA; ~10% have moderate-to-severe disease (Peppard 2013, NHANES-linked Wisconsin Sleep Cohort)
Demographics
Men 2-3x more affected than premenopausal women; risk in women rises sharply after menopause; obesity is the dominant modifiable driver
Avg. age
Diagnosis most often between ages 40-70; pediatric OSA peaks at ages 2-8 due to tonsil/adenoid hypertrophy
Global cases
~936 million adults aged 30-69 with OSA worldwide; ~425 million moderate-to-severe (Benjafield 2019, Lancet Respir Med)
Specialist
Pulmonology
ICD-10
G47.30
§ 02
How you might notice it
The key symptoms of Sleep Apnea are: Loud habitual snoring most nights, often reported by a bed partner long before the patient seeks care; present in roughly 90% of moderate-to-severe OSA., Witnessed pauses in breathing during sleep followed by a gasp, snort, or choking arousal — the single most specific symptom for OSA., Excessive daytime sleepiness with Epworth Sleepiness Scale score ≥10, falling asleep while reading, watching TV, or stopped in traffic., Non-restorative sleep — waking unrefreshed despite seven or more hours in bed, often with morning grogginess that takes an hour to clear., Morning headaches, typically frontal and dull, that fade over 1-2 hours after waking (driven by overnight CO2 retention and vascular dilation)., Nocturia — waking two or more times nightly to urinate, caused by atrial natriuretic peptide release during apneic events; often misattributed to prostate or bladder issues., Dry mouth or sore throat on waking, reflecting mouth breathing and airway turbulence..
01Loud habitual snoring most nights, often reported by a bed partner long before the patient seeks care; present in roughly 90% of moderate-to-severe OSA.
02Witnessed pauses in breathing during sleep followed by a gasp, snort, or choking arousal — the single most specific symptom for OSA.
03Excessive daytime sleepiness with Epworth Sleepiness Scale score ≥10, falling asleep while reading, watching TV, or stopped in traffic.
04Non-restorative sleep — waking unrefreshed despite seven or more hours in bed, often with morning grogginess that takes an hour to clear.
§ 03
How it’s diagnosed
diagnosis
Diagnosis of sleep apnea combines a focused history, validated questionnaires, and an objective sleep study. The history targets snoring, witnessed apneas, gasping arousals, daytime sleepiness (Epworth Sleepiness Scale), nocturia, morning headaches, and bed-partner observations. Screening tools include the STOP-BANG questionnaire (Snoring, Tiredness, Observed apnea, blood Pressure, BMI >35, Age >50, Neck >40 cm, Gender male) — a score of 3 or more is sensitive for OSA and a score of 5-8 strongly predicts moderate-to-severe disease. Examination notes BMI, neck circumference, retrognathia, dental crowding, modified Mallampati score, tonsil size, and nasal patency. The definitive diagnostic test is a sleep study. The American Academy of Sleep Medicine 2017 guidelines support two pathways: in-laboratory polysomnography (PSG, the gold standard) for patients with significant comorbidities, suspected central apnea, complex sleep complaints, or non-diagnostic home testing; and home sleep apnea testing (HSAT) for adults with a high pre-test probability of moderate-to-severe uncomplicated OSA. A negative or inconclusive HSAT in a symptomatic patient should be followed by in-lab PSG rather than treated as a normal result. Severity is graded by AHI: mild 5-15, moderate 15-30, severe >30 events per hour, with attention also to the oxygen desaturation index (ODI) and the lowest nadir SpO2. In treatment-resistant disease, drug-induced sleep endoscopy (DISE) helps localize the level of upper airway collapse and informs surgical or hypoglossal nerve stimulation selection. Comorbid conditions warrant parallel work-up: morning blood pressure, fasting glucose, lipid panel, and an ECG are reasonable when OSA is confirmed.
Key tests
01
In-laboratory polysomnography (PSG)Gold-standard diagnostic study. Records EEG sleep stages, EOG, EMG, ECG, airflow, respiratory effort, oxygen saturation, body position, and snoring. Detects OSA, CSA, parasomnias, periodic limb movements, and oxygen desaturation patterns.
Hypoglossal nerve stimulation (Inspire upper airway stimulation)STAR trial reported AHI reduction of approximately 68% at 12 months with durable response at 5 years; treatment success in 60-75% of selected patients.
Adenotonsillectomy (pediatric)Resolves OSA in 70-80% of children; higher success in non-obese children without craniofacial syndromes.
Maxillomandibular advancement (MMA)Surgical success (AHI <20 and reduction ≥50%) in 80-90% of selected patients; cure rates 40-50%.
Uvulopalatopharyngoplasty (UPPP) and palate proceduresTreatment success in 40-60% of selected patients; outcomes depend heavily on appropriate DISE-guided selection.
§ 05
Causes & risk factors
known causes
Upper airway anatomic crowding
A small or set-back jaw (retrognathia), large tongue (macroglossia), enlarged tonsils, long soft palate, lateral pharyngeal fat pads, and narrow nasal passages all reduce the cross-sectional area of the airway. When pharyngeal dilator muscle tone falls in sleep, the airway collapses where it is already narrowest.
Obesity and pharyngeal fat deposition
Adipose tissue accumulates around the tongue and lateral pharyngeal walls, narrowing the airway and increasing its collapsibility. Each 10% rise in body weight is associated with roughly a 30% increase in AHI in longitudinal data. Central obesity also restricts diaphragm excursion and reduces functional residual capacity.
Reduced pharyngeal muscle tone during sleep
Genioglossus and other airway dilator muscles relax during sleep, especially in REM. In susceptible patients this normal relaxation tips a borderline airway into repeated collapse. Alcohol, benzodiazepines, opioids, and muscle relaxants amplify this drop in tone.
Unstable respiratory control (high loop gain)
Some patients have an oversensitive ventilatory feedback loop — small changes in CO2 produce large changes in breathing effort, driving cyclic over- and under-ventilation. This pathway is dominant in central sleep apnea and contributes to treatment-emergent CSA on CPAP.
Heart failure with reduced or preserved ejection fraction
Pulmonary congestion stimulates vagal afferents and produces hyperventilation that drives the PaCO2 below the apnea threshold, generating Cheyne-Stokes respiration with central apneas. CSA prevalence reaches 30-50% in advanced systolic heart failure.
Chronic opioid use
Long-term opioid therapy suppresses central respiratory drive and produces ataxic breathing patterns with central apneas and oxygen desaturation. Methadone maintenance is a particularly common cause.
§ 06
Living with it
01Maintain a healthy body weight — even 5-10% weight loss measurably lowers AHI and may avert the need for PAP in mild disease
02Limit alcohol within 3 hours of bedtime and avoid bedtime sedatives where possible; both worsen airway collapse
03Quit smoking — smokers carry roughly 3x the OSA risk of never-smokers; quitting reduces upper-airway inflammation
05Sleep on the side rather than the back in supine-predominant disease — confirmed on the diagnostic study
recommended foods
•Mediterranean-style eating pattern with vegetables, legumes, whole grains, olive oil, and fish — associated with lower AHI in trial data
•High-fiber foods that support sustained weight loss and improved insulin sensitivity
•Lean proteins distributed across the day to preserve lean mass during weight reduction
•
§ 07
When to seek help
why see a pulmonology
A sleep medicine physician should be involved when home testing is negative but symptoms persist, when central or complex apnea is suspected, when CPAP fails or is rejected, when surgical or hypoglossal nerve stimulation is being considered, when severe hypoxia or hypoventilation is present, or when sleep apnea coexists with heart failure, refractory hypertension, or stroke. Many adults with high pre-test probability and uncomplicated OSA can be evaluated and started on therapy by a trained primary care or pulmonary clinician with access to home sleep testing.
Obstructive sleep apnea (OSA, G47.33)Repetitive upper airway collapse during sleep despite ongoing respiratory effort. Accounts for over 90% of adult sleep apnea. Strongly linked to obesity, craniofacial anatomy, male sex, and aging.
Central sleep apnea (CSA, G47.31)Cessation of airflow without respiratory effort, caused by transient loss of brainstem respiratory drive. Common in heart failure (Cheyne-Stokes respiration), chronic opioid use, high-altitude periodic breathing, and after stroke.
Complex / treatment-emergent CSACentral apneas that appear or worsen after starting CPAP for OSA. Occurs in roughly 5-15% of patients starting CPAP; often resolves over weeks but sometimes requires adaptive servo-ventilation.
Pediatric OSAMost often caused by adenotonsillar hypertrophy in children aged 2-8. Presents with snoring, restless sleep, mouth breathing, bedwetting, and behavioral or attention problems rather than classic daytime sleepiness. Adenotonsillectomy is first-line.
Obesity hypoventilation syndrome (OHS)Daytime hypercapnia (PaCO2 > 45 mmHg) in patients with BMI ≥30 and sleep-disordered breathing, after other causes excluded. Carries higher cardiovascular mortality than OSA alone and usually needs bilevel PAP.
Living with Sleep Apnea
Timeline
Sleep apnea is a chronic condition rather than an episode that recovers. With PAP therapy started, snoring stops on the first night, witnessed apneas resolve within nights, daytime sleepiness typically improves over 2-4 weeks, and mood and concentration gains accumulate over 2-3 months. Blood pressure improvements appear within 1-3 months. After surgical treatment (UPPP, MMA, Inspire implantation), post-operative recovery runs 2-6 weeks, with full assessment of therapeutic response on a repeat sleep study at 3-6 months. Weight-loss strategies (tirzepatide, bariatric surgery) produce progressive AHI improvement over 6-18 months as body composition changes.
Lifestyle
01Use the prescribed PAP device every night, including naps — partial-night use leaves residual cardiovascular and sleepiness risk
02Maintain a regular sleep schedule with 7-9 hours in bed to reduce sleep deprivation that worsens airway collapse
03Engage in regular moderate aerobic exercise — independently reduces AHI by 20-25% in clinical trials, even without weight loss
04Avoid alcohol within 3 hours of bedtime; minimize sedating antihistamines, benzodiazepines, and opioids where clinically possible
05Sleep on the side using a positional therapy device if supine-predominant OSA is confirmed
06Keep mask, tubing, and humidifier clean per manufacturer guidance — replace cushions and filters on schedule
07Treat allergic rhinitis with nasal steroids to improve PAP comfort and adherence
Complementary approaches
Oropharyngeal (myofunctional) exercisesDaily exercises targeting tongue, soft palate, and pharyngeal wall muscles. Randomized trials show modest AHI reduction of roughly 30-50% in mild-to-moderate OSA when performed consistently for 3 months. Adjunctive only — not a substitute for PAP in moderate-to-severe disease.
Didgeridoo or wind-instrument practiceA 2006 BMJ randomized trial (Puhan) showed daily didgeridoo practice reduced AHI and partner-reported snoring in moderate OSA. Mechanism is presumed strengthening of upper airway dilator muscles. Reasonable adjunct in motivated patients.
Choosing a doctor
Look for board certification in sleep medicine (often via pulmonology, neurology, ENT, or internal medicine), affiliation with an AASM-accredited sleep center, access to both in-lab PSG and home sleep apnea testing, and a clinic with structured CPAP setup and follow-up (mask fitting, downloaded adherence data, telehealth check-ins). For surgical or hypoglossal nerve stimulation evaluation, an ENT/otolaryngologist trained in DISE and Inspire implantation is the right referral. Continuity of care matters — sleep apnea management is a multi-year relationship and adherence support is the strongest predictor of long-term success.
Sleep apnea is a disorder in which breathing repeatedly stops or becomes shallow during sleep. The obstructive form is caused by the upper airway collapsing when throat muscles relax; the central form is caused by the brain failing to signal breaths. Each event lasts at least 10 seconds and ends in a brief arousal or oxygen drop. Untreated moderate-to-severe disease raises long-term risk of high blood pressure, atrial fibrillation, stroke, and motor vehicle crashes.
How common is sleep apnea?▾▴
An estimated 936 million adults aged 30-69 worldwide have obstructive sleep apnea, with 425 million in the moderate-to-severe range (Benjafield 2019). In the US, roughly 26% of adults aged 30-70 have at least mild OSA and 10% have moderate-to-severe disease.
What are the main symptoms of sleep apnea?▾▴
Loud habitual snoring, witnessed pauses in breathing followed by gasps, daytime sleepiness, non-restorative sleep, morning headaches, nocturia, and difficulty concentrating. Bed partners often notice the breathing pauses before the patient feels tired.
How is sleep apnea diagnosed?▾▴
Diagnosis requires an objective sleep study — either in-laboratory polysomnography (the gold standard) or a home sleep apnea test in adults with high pre-test probability of uncomplicated OSA. Severity is graded by the apnea-hypopnea index: mild 5-15, moderate 15-30, severe over 30 events per hour.
What is a normal AHI?▾▴
An AHI below 5 events per hour is normal in adults. AHI 5-15 is mild sleep apnea, 15-30 is moderate, and over 30 is severe. The pediatric threshold is lower — an AHI of 1 or more is abnormal in children.
What is CPAP and how does it work?▾▴
CPAP (continuous positive airway pressure) delivers a steady stream of air through a mask to splint the upper airway open during sleep. With consistent nightly use it normalizes the apnea-hypopnea index in over 90% of patients and is first-line for moderate-to-severe OSA.
Is CPAP comfortable?▾▴
Most users adapt within 1-4 weeks with the right mask, pressure setting, and humidification. Long-term adherence of 4+ hours nightly is reached by roughly half of patients without active support; mask refitting and telehealth coaching substantially improve it.
How long does it take CPAP to work?▾▴
Snoring usually stops on the first night. Daytime sleepiness improves over 2-4 weeks of consistent use. Blood pressure, mood, and concentration gains accumulate over 1-3 months, with cardiovascular benefits building over years of adherent therapy.
Can sleep apnea be cured?▾▴
Adult sleep apnea is usually controlled rather than cured and most cases need ongoing therapy. Pediatric OSA from enlarged tonsils is often cured by adenotonsillectomy. Adult OSA can resolve with substantial weight loss or maxillomandibular advancement surgery in selected patients.
What is a home sleep apnea test?▾▴
A home sleep apnea test is a portable monitor used at home for one or two nights. It records airflow, breathing effort, oxygen saturation, and pulse. AASM recommends it as first-line for adults with high pre-test probability of moderate-to-severe uncomplicated OSA.
When do I need an in-lab sleep study?▾▴
In-lab polysomnography is preferred when significant cardiopulmonary or neuromuscular disease, severe insomnia, suspected central sleep apnea, or other sleep disorders are present, and when home testing is negative despite ongoing symptoms. Children should generally have in-lab studies.
What is the difference between obstructive and central sleep apnea?▾▴
Obstructive sleep apnea is caused by physical collapse of the upper airway — effort continues but airflow stops. Central sleep apnea is caused by transient loss of brainstem respiratory drive — both effort and airflow stop. OSA accounts for over 90% of adult cases.
Can losing weight cure sleep apnea?▾▴
Weight loss measurably reduces the apnea-hypopnea index. A 10% reduction in body weight typically lowers AHI by 20-30%, and bariatric surgery resolves OSA in 40-60% of cases. Some patients with non-fat anatomic factors still need PAP after weight loss.
Does sleep apnea cause high blood pressure?▾▴
Untreated moderate-to-severe sleep apnea independently raises blood pressure and is found in an estimated 30-40% of patients with resistant hypertension. Adherent CPAP therapy lowers blood pressure by 2-3 mmHg on average, with larger effects in resistant cases.
Can sleep apnea cause atrial fibrillation?▾▴
Yes — moderate-to-severe sleep apnea is strongly associated with atrial fibrillation, and untreated OSA roughly doubles the risk of AFib recurrence after catheter ablation. Cardiology guidelines recommend screening for OSA in patients with new or recurrent AFib.
What is an oral appliance for sleep apnea?▾▴
An oral appliance is a custom-fitted dental device worn at night that advances the lower jaw 5-10 mm to widen the airway. It is most effective for mild-to-moderate OSA and for moderate OSA in CPAP-intolerant patients, reducing AHI by 50% or more in well-selected cases.
What is the Inspire implant?▾▴
Inspire is an implanted hypoglossal nerve stimulator that activates tongue muscles during inspiration to open the airway. It is for adults with moderate-to-severe OSA who failed CPAP. STAR trial data show roughly 68% AHI reduction at 12 months with durable 5-year response.
Can sleep apnea kill you?▾▴
Severe untreated sleep apnea raises long-term mortality, mostly through cardiovascular events — stroke, myocardial infarction, sudden cardiac death, and decompensated heart failure. It also raises fatal motor vehicle crash risk. Adherent treatment reduces this excess risk substantially.
Is sleep apnea common in children?▾▴
Pediatric OSA affects 1-5% of children, peaking at ages 2-8. The most common cause is enlarged tonsils and adenoids. Children present with snoring, restless sleep, mouth breathing, bedwetting, and behavioral problems. Adenotonsillectomy resolves OSA in 70-80% of children.
Can women get sleep apnea?▾▴
Yes. Women are affected at roughly half the rate of men before menopause, but prevalence rises sharply afterward and approaches male rates within a decade. Women more often present with insomnia, fatigue, mood symptoms, and morning headaches, which contributes to underdiagnosis.
How much does a sleep study cost?▾▴
In the US, an in-lab polysomnogram typically costs USD 1,500-3,000 before insurance, while a home sleep apnea test runs USD 200-500. A CPAP machine costs roughly USD 500-1,200. Most US commercial and Medicare plans cover sleep studies and PAP therapy with documented OSA.
Can sleep apnea affect driving safety?▾▴
Yes — drivers with untreated moderate-to-severe sleep apnea have roughly 2 to 2.5 times the motor vehicle crash risk of non-OSA drivers, driven by microsleeps and impaired reaction time. Adherent CPAP treatment normalizes this excess crash risk within months.
Can medication treat sleep apnea?▾▴
Tirzepatide became the first medication FDA-approved for moderate-to-severe OSA in adults with obesity in 2024, based on the SURMOUNT-OSA trial. It reduced AHI by roughly 25-30 events per hour — a 50-60% relative reduction. No drug currently replaces PAP for severe OSA.
Morning headaches, typically frontal and dull, that fade over 1-2 hours after waking (driven by overnight CO2 retention and vascular dilation).
06Nocturia — waking two or more times nightly to urinate, caused by atrial natriuretic peptide release during apneic events; often misattributed to prostate or bladder issues.
07Dry mouth or sore throat on waking, reflecting mouth breathing and airway turbulence.
08Difficulty concentrating, slowed thinking, and memory lapses through the day; mood changes including irritability and low motivation.
09Reduced libido and erectile dysfunction in men, partly mediated by repeated overnight desaturations and sleep fragmentation.
10Reflux symptoms at night and worsening of nocturnal asthma — both linked mechanistically to negative intrathoracic pressure swings during obstructed breaths.
11Restless, thrashing sleep with frequent position changes and tangled bedding noted by a bed partner.
12Falling asleep at the wheel or near-miss driving events — a critical safety symptom that warrants urgent assessment.
early warning signs
•New or worsening snoring after weight gain, alcohol intake, or starting a sedative
•Bed partner reports of pauses or gasps even before the patient feels tired
•Resistant hypertension that needs three or more antihypertensives to control
•Unexplained daytime fatigue with an Epworth score of 10 or above
•Nocturia in a younger adult without urologic disease
● emergency signs
•Falling asleep at the wheel, behind machinery, or during a single conversation — stop driving and seek same-week sleep evaluation
•Severe morning headaches with confusion or shortness of breath at rest — consider obesity hypoventilation syndrome or hypercapnic respiratory failure
•Cyanosis, marked daytime hypoxia, or oxygen saturation persistently below 90% on awake pulse oximetry — emergency assessment
•New atrial fibrillation, heart failure decompensation, or a stroke event in someone with suspected untreated severe OSA — coordinated cardiology and sleep work-up
•Suspected OSA in a patient about to undergo surgery with general anesthesia — perioperative airway and recovery risk should be assessed urgently
Portable monitoring for adults with high pre-test probability of moderate-to-severe uncomplicated OSA. Measures airflow, respiratory effort, oxygen saturation, and pulse, but does not stage sleep. Recommended first-line for straightforward OSA per AASM 2017.
03
Epworth Sleepiness Scale (ESS) and STOP-BANG questionnaireValidated screening tools. ESS quantifies subjective daytime sleepiness (score ≥10 abnormal); STOP-BANG estimates the probability of moderate-to-severe OSA and guides referral.
04
Overnight pulse oximetryInexpensive screening that records nocturnal oxygen saturation. Useful for triage, perioperative screening, and in low-resource settings. Cannot distinguish OSA from CSA or hypoventilation.
05
Drug-induced sleep endoscopy (DISE)Visualizes the level and pattern of airway collapse under propofol sedation. Indicated when CPAP fails or is rejected and surgical or hypoglossal nerve stimulation options are being considered.
06
Cephalometry and 3D imagingQuantifies craniofacial anatomy — mandibular position, posterior airway space, hyoid position. Used in orthodontic and maxillofacial planning for oral appliance fit or maxillomandibular advancement.
07
Echocardiogram and ECGIdentifies left ventricular dysfunction, pulmonary hypertension, or atrial fibrillation that frequently coexists with sleep apnea. Particularly important when central sleep apnea is suspected.
Outlook
With consistent therapy at four or more hours nightly, prognosis is excellent. Daytime sleepiness improves within days to weeks, blood pressure falls modestly within 1-3 months, mood and quality of life improve over 3-6 months, and the long-term cardiovascular trajectory bends toward that of age-matched non-OSA peers. Untreated moderate-to-severe OSA, by contrast, raises the long-term risk of incident hypertension, atrial fibrillation, stroke, myocardial infarction, type 2 diabetes, and motor vehicle crashes by approximately 2-3 fold (Sleep Heart Health Study and other longitudinal cohorts). All-cause mortality is elevated in severe untreated disease, with the excess concentrated in cardiovascular events. The strongest prognostic factor is adherence — patients using PAP at least 6 hours per night derive substantially greater symptomatic and cardiovascular benefit than those using it less. For patients matched well to surgical or device therapy, durable response at 5 years is achievable in 60-80% of selected cases.
Hypothyroidism and acromegaly
Hypothyroidism causes tongue and pharyngeal soft tissue edema plus reduced ventilatory drive. Acromegaly enlarges the tongue and soft tissues directly. Both warrant screening when sleep apnea presents with atypical features or refractory disease.
Adenotonsillar hypertrophy (pediatric)
Enlarged tonsils and adenoids physically narrow the pediatric pharynx. This is the single most common cause of childhood OSA and the reason adenotonsillectomy resolves 70-80% of pediatric cases.
risk factors
Obesity (BMI ≥30)modifiable
The dominant modifiable risk factor. Each one-standard-deviation rise in BMI roughly doubles OSA risk. Neck circumference >43 cm (17 in) in men or >40 cm in women adds independent predictive value.
Male sexnon-modifiable
Men have 2-3x the prevalence of premenopausal women, driven by upper airway length and fat distribution. The gap narrows after menopause.
Age 40-70non-modifiable
Prevalence rises with age as pharyngeal muscle tone declines and connective tissue elasticity falls. Severity tends to plateau after the seventh decade.
Craniofacial anatomy (retrognathia, narrow maxilla, large tonsils)non-modifiable
Anatomic crowding is a strong predictor in non-obese patients. Family clustering of jaw shape contributes to the heritable component of OSA risk.
Family history of OSAgenetic
First-degree relatives of OSA patients have roughly twice the risk. Heritability estimates from twin studies are 30-40%, mediated through craniofacial structure, fat distribution, and ventilatory control.
Postmenopausal statusnon-modifiable
Loss of progesterone-mediated airway tone and shifting fat distribution raise women's OSA risk to approximately male levels within a decade of menopause.
Alcohol, sedatives, and opioid usemodifiable
All reduce pharyngeal dilator tone or central respiratory drive. Avoiding alcohol within 3 hours of sleep measurably reduces AHI in mild-to-moderate OSA.
Smokingmodifiable
Smokers have roughly 3x the OSA risk of never-smokers, likely from upper airway inflammation and edema. Quitting partially reverses this.
Type 2 diabetes and metabolic syndromemodifiable
Bidirectional relationship — OSA worsens insulin resistance, and diabetes is associated with autonomic neuropathy affecting airway tone. Roughly 50% of patients with type 2 diabetes have undiagnosed OSA.
Pregnancynon-modifiable
Weight gain, nasal mucosal congestion, and elevated diaphragm raise OSA risk in the third trimester. Gestational OSA increases gestational hypertension and pre-eclampsia risk.
Adequate hydration during the day; reduce fluids in the 2 hours before bed to limit nocturia
•Caffeine before noon only — late-day caffeine worsens sleep fragmentation
•Plant-based foods rich in magnesium and potassium, which support cardiovascular health in OSA patients
foods to avoid
•Alcohol within 3 hours of bedtime
•Large heavy meals within 3 hours of bedtime — reflux worsens overnight airway irritation
•Sugar-sweetened beverages and refined carbohydrates that drive weight gain and insulin resistance
•Excess sodium when hypertension or heart failure coexist
•Nicotine-containing products, including evening vaping
•Sedating over-the-counter sleep aids (diphenhydramine) that reduce airway tone
06
Motor vehicle crashes — drivers with untreated OSA carry roughly 2-2.5x the crash risk of non-OSA drivers; treatment normalizes this excess
07Perioperative complications including airway obstruction in recovery and postoperative respiratory failure
08Pulmonary hypertension in chronic severe disease, particularly with coexisting obesity hypoventilation
09Sudden cardiac death — relative risk during sleeping hours is elevated in severe OSA
10Depression, anxiety, and reduced cognitive performance that improve with adherent therapy
choosing the right hospital
01AASM accreditation for the affiliated sleep laboratory
02Capacity for both in-lab polysomnography and home sleep apnea testing
03On-site or partnered dental sleep medicine for oral appliance therapy
04ENT surgical program offering drug-induced sleep endoscopy and hypoglossal nerve stimulation implantation
05Multidisciplinary integration with cardiology, bariatric, and pulmonary services
Essential facilities
Hospital-based AASM-accredited sleep laboratoryOutpatient sleep clinic with CPAP setup and adherence-tracking programENT surgical center with DISE capabilityDental sleep medicine practice for custom oral appliancesBariatric surgery program for OSA with severe obesity
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08Inform anesthesiologists and surgeons of the OSA diagnosis before any procedure requiring sedation
Daily management
01Use CPAP or the prescribed therapy every night and during daytime naps; aim for ≥4 hours every night and ideally full sleep duration
02Check the CPAP machine's adherence and residual AHI data at each clinic visit; share trends with the sleep team
03Refit the mask if leaks, skin marks, or pressure sores develop — small adjustments dramatically improve adherence
04Maintain stable sleep and wake times across weekdays and weekends
05Track daytime sleepiness with periodic Epworth scores; rising scores signal a need for clinical review
06Re-evaluate after major weight change, new medication, pregnancy, or new cardiovascular diagnosis — therapy needs may shift
Exercise
Aim for 150 minutes per week of moderate aerobic activity (brisk walking, cycling, swimming) plus 2 sessions of resistance training. Regular exercise reduces AHI independently of weight loss in randomized trials, improves daytime alertness, and lowers blood pressure. Patients with severe untreated OSA should avoid extreme exertion or competitive driving sports until treatment is established and daytime sleepiness has improved.