Associate Clinical Professor of Medicine
Ask patients and their sleeping partner and/or family members about symptoms including snoring, apneas, awakenings due to gasping or choking, daytime sleepiness, fatigue, poor concentration, nasal congestion, weight gain, and morning headaches.
Obtain a sleep study using formal in-laboratory polysomnography for the most accurate diagnosis of OSA.
Use the results of the sleep study to determine the severity of OSA.
Define mild OSA as an AHI (or RDI) between 5 and 15. Patients with mild OSA often report sleepiness when they are sedentary and under-stimulated.
Define moderate OSA as an AHI (or RDI) between 15 and 30. Patients with moderate OSA often report sleepiness more often throughout the day.
Define severe OSA as an AHI (or RDI) more than 30. Patients with severe OSA often have sleepiness that interferes significantly with daily activities.
Treat the majority of patients with OSA with CPAP.
Consider oral appliances for patients who are unable to adhere to CPAP.
Consider surgical treatment for appropriate patients.
Consider a trial of modafinil for patients with residual excessive daytime sleepiness who have no other identifiable cause for their sleepiness.
The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, FACP, Editor.