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((short description|Disorder involving pauses in breathing during sleep))
((cs1 config|name-list-style=vanc))
((Use dmy dates|date=June 2023))
((Infobox medical condition (new)
| name          = Sleep breathing disorder
| image         = Obstruction ventilation apnée sommeil.svg
| caption       = Obstructive sleep apnea
| pronounce     = ((IPAc-en|æ|p|ˈ|n|iː|ə)), ((IPAc-en|ˈ|æ|p|n|i|ə))
| synonyms      = Sleep apnoea, sleep apnea syndrome
| field         = [[Otorhinolaryngology]], [[sleep medicine]]
| symptoms      = [[apnea|Pauses breathing]] or periods of [[hypopnea|shallow breathing]] during [[sleep]], [[snoring]], tired during the day<ref name=NIH2012What/><ref name=NIH2012Sym/>
| complications = [[myocardial infarction|Heart attack]], [[Cardiac arrest]],  [[stroke]], [[diabetes]], [[heart failure]], [[irregular heartbeat]], [[obesity]], [[motor vehicle collisions]],<ref name=NIH2012What/> [[Alzheimer's disease]],<ref name="Jackson et al 2020">((cite journal |last1=Jackson |first1=Melinda L. |last2=Cavuoto |first2=Marina |last3=Schembri |first3=Rachel |last4=Doré |first4=Vincent |last5=Villemagne |first5=Victor L. |last6=Barnes |first6=Maree |last7=O'Donoghue |first7=Fergal J. |last8=Rowe |first8=Christopher C. |last9=Robinson |first9=Stephen R. |title=Severe Obstructive Sleep Apnea Is Associated with Higher Brain Amyloid Burden: A Preliminary PET Imaging Study |journal=Journal of Alzheimer's Disease |date=10 November 2020 |volume=78 |issue=2 |pages=611–617 |doi=10.3233/JAD-200571 |pmid=33016907 |s2cid=222145149 |url=https://www.sciencedaily.com/releases/2020/11/201111104918.htm |url-access=subscription ))</ref> and premature death<ref>((cite journal |last1=Young |first1=Terry |last2=Finn |first2=Laurel |last3=Peppard |first3=Paul E. |last4=Szklo-Coxe |first4=Mariana |last5=Austin |first5=Diane |last6=Nieto |first6=F. Javier |last7=Stubbs |first7=Robin |last8=Hla |first8=K. Mae |title=Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up of the Wisconsin Sleep Cohort |journal=Sleep |date=1 August 2008 |volume=31 |issue=8 |pages=1071–1078 |pmid=18714778 |pmc=2542952 |url=https://aasm.org/study-shows-that-people-with-sleep-apnea-have-a-high-risk-of-death/ ))</ref>
| onset         = Varies; up to 50% of women age 20–70<ref name="ReferenceC">((cite journal|pmc = 4561280|year = 2015|last1 = Franklin|first1 = K. A.|last2 = Lindberg|first2 = E.|title = Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea|journal = Journal of Thoracic Disease|volume = 7|issue = 8|pages = 1311–1322|doi = 10.3978/j.issn.2072-1439.2015.06.11|pmid = 26380759))</ref>
| duration      =
| causes        =
| risks         = [[Overweight]], family history, [[allergies]], enlarged [[tonsils]],<ref name=NIH2012Cau/> [[asthma]]<ref name="asthma_Ref">((cite journal |last1=Dixit |last2=Ramakant |year=2018 |title=Asthma and obstructive sleep apnea: More than an association! |journal=Lung India |volume=35 |issue=3 |pages=191–192 |doi=10.4103/lungindia.lungindia_241_17 |pmc=5946549 |pmid=29697073 |doi-access=free ))</ref>
| diagnosis     = Overnight [[Polysomnography|sleep study]]<ref name=NIH2012Diag/>
| differential  =
| prevention    =
| treatment     = Lifestyle changes, mouthpieces, breathing devices, surgery<ref name=NIH2012What/>
| medication    =
| prognosis     =
| frequency     = ~ 1 in every 10 people,<ref name="Jackson et al 2020"/><ref name="Owen et al 2020">((cite journal |last1=Owen |first1=Jessica E |last2=Benediktsdottir |first2=Bryndis |last3=Cook |first3=Elizabeth |last4=Olafsson |first4=Isleifur |last5=Gislason |first5=Thorarinn |last6=Robinson |first6=Stephen R |title=Alzheimer's disease neuropathology in the hippocampus and brainstem of people with obstructive sleep apnea |journal=Sleep |date=21 September 2020 |volume=44 |issue=3 |pages=zsaa195 |doi=10.1093/sleep/zsaa195 |pmid=32954401 |url=https://www.sciencedaily.com/releases/2020/09/200928103416.htm |doi-access=free ))</ref> 2:1 ratio of men to women, aging and obesity higher risk<ref name="ReferenceC"/>
| deaths        =
| alt           =
| types         = [[Obstructive sleep apnea]] (OSA), [[central sleep apnea]] (CSA), mixed sleep apnea<ref name=NIH2012What/>
))
<!-- Definition -->
'''Sleep apnea''', also spelled '''sleep apnoea''', is a [[sleep disorder]] in which [[apnea|pauses in breathing]] or periods of [[hypopnea|shallow breathing]] during [[sleep]] occur more often than normal.<ref name=NIH2012What>((cite web|url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/|title=Sleep Apnea: What Is Sleep Apnea?|date=10 July 2012|work=NHLBI: Health Information for the Public|publisher=U.S. Department of Health and Human Services|archive-url=https://web.archive.org/web/20160819043218/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/|archive-date=19 August 2016|access-date=18 August 2016|url-status=live))</ref> Each pause can last for a few seconds to a few minutes and they happen many times a night.<ref name=NIH2012What/> In the most common form, this follows loud [[snoring]].<ref name=NIH2012Sym>((cite web|title=What Are the Signs and Symptoms of Sleep Apnea?|url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/signs|website=NHLBI|access-date=18 August 2016|date=10 July 2012|url-status=live|archive-url=https://web.archive.org/web/20160826185448/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/signs|archive-date=26 August 2016))</ref> A choking or snorting sound may occur as breathing resumes.<ref name=NIH2012What/> Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day.<ref name=NIH2012What/> In children, it may cause hyperactivity or problems in school.<ref name=NIH2012Sym/>

<!-- Cause and diagnosis-->
Sleep apnea may be either [[obstructive sleep apnea]] (OSA), in which breathing is interrupted by a blockage of air flow, [[central sleep apnea]] (CSA), in which regular unconscious breath simply stops, or a combination of the two.<ref name=NIH2012What/> OSA is the most common form.<ref name=NIH2012What/> OSA has four key contributors; these include a narrow, crowded, or collapsible upper airway, an ineffective pharyngeal dilator muscle function during sleep, airway narrowing during sleep, and unstable control of breathing (high loop gain).<ref name="Dolgin">((cite journal |last1=Dolgin |first1=Elie |title=Treating sleep apnea with pills instead of machines |journal=Knowable Magazine |date=29 April 2020 |doi=10.1146/knowable-042820-1|doi-access=free |url=https://knowablemagazine.org/article/health-disease/2020/treating-sleep-apnea-pills-instead-machines |access-date=9 May 2022))</ref><ref>((cite journal|pmc = 5789079|year = 2018|last1 = Osman|first1 = A. M.|last2 = Carter|first2 = S. G.|last3 = Carberry|first3 = J. C.|last4 = Eckert|first4 = D. J.|title = Obstructive sleep apnea: Current perspectives|journal = Nature and Science of Sleep|volume = 10|pages = 21–34|doi = 10.2147/NSS.S124657|pmid = 29416383 | doi-access=free ))</ref> It is often a chronic condition.((medical citation needed|data=February 2024|date=February 2024))

Other risk factors include being overweight,<ref name="Lim"/> a family history of the condition, allergies, and enlarged [[tonsils]].<ref name=NIH2012Cau>((cite web|title=Who Is at Risk for Sleep Apnea?|url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/atrisk|website=NHLBI|access-date=18 August 2016|date=10 July 2012|url-status=live|archive-url=https://web.archive.org/web/20160826160854/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/atrisk|archive-date=26 August 2016))</ref> Some people with sleep apnea are unaware they have the condition.<ref name=NIH2012What/> In many cases it is first observed by a family member.<ref name=NIH2012What/> Sleep apnea is often diagnosed with an overnight [[Polysomnography|sleep study]].<ref name=NIH2012Diag>((cite web|title=How Is Sleep Apnea Diagnosed?|url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/diagnosis|website=NHLBI|access-date=18 August 2016|date=10 July 2012|url-status=live|archive-url=https://web.archive.org/web/20160811134644/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/diagnosis|archive-date=11 August 2016))</ref> For a diagnosis of sleep apnea, more than five episodes per hour must occur.<ref name=De2013>((cite journal | vauthors = De Backer W | title = Obstructive sleep apnea/hypopnea syndrome | journal = Panminerva Medica | volume = 55 | issue = 2 | pages = 191–5 | date = June 2013 | pmid = 23676959 ))</ref>

In CSA, the basic neurological controls for breathing rate malfunction and fail to give the signal to inhale, causing the individual to miss one or more cycles of breathing. If the pause in breathing is long enough, the percentage of oxygen in the circulation can drop to a lower than normal level ([[hypoxaemia]]) and the concentration of carbon dioxide can build to a higher than normal level ([[hypercapnia]]).<ref>((cite book|url=https://www.ncbi.nlm.nih.gov/books/NBK482456/|title=Physiology, Carbon Dioxide Retention|last1=Majmundar|first1=Sapan H.|last2=Patel|first2=Shivani|date=27 October 2018|publisher=StatPearls Publishing|pmid=29494063))</ref> In turn, these conditions of [[Hypoxia (medical)|hypoxia]] and [[hypercapnia]] will trigger ''additional'' effects on the body (such as [[Cheyne-stokes respiration|Cheyne-Stokes Respiration]]).<ref>((cite book |last1=Rudrappa |first1=M. |last2=Modi |first2=P. |last3=Bollu |first3=P.C. |title=Cheyne Stokes Respirations |date=1 August 2022 |publisher=StatPearls Publishing |location=Treasure Island, FL |year=2022 |pmid=28846350 |isbn= |url=https://www.ncbi.nlm.nih.gov/books/NBK448165/ |accessdate=))</ref> Brain cells need constant oxygen to live, and if the level of blood oxygen goes low enough for long enough, brain damage and even death can occur.((medical citation needed|data=February 2024|date=February 2024))

A systemic disorder, sleep apnea is associated with a wide array of effects, including increased risk of [[car accidents]], [[hypertension]], [[cardiovascular disease]], [[myocardial infarction]], [[stroke]], [[atrial fibrillation]], [[insulin resistance]], higher incidence of [[cancer]], and [[neurodegeneration]].<ref name="Lim">((cite journal |last1=Lim |first1=Diane C. |last2=Pack |first2=Allan I. |title=Obstructive Sleep Apnea: Update and Future |journal=Annual Review of Medicine |date=14 January 2017 |volume=68 |issue=1 |pages=99–112 |doi=10.1146/annurev-med-042915-102623 |pmid=27732789 |url=https://www.annualreviews.org/doi/10.1146/annurev-med-042915-102623 |access-date=10 May 2022 |issn=0066-4219|url-access=subscription ))</ref> The exact effects of the condition depend on how severe the apnea is and on the individual characteristics of the person having the apnea.((medical citation needed|data=February 2024|date=February 2024))

<!-- Prevention, treatment, prognosis -->
Treatment may include lifestyle changes, mouthpieces, breathing devices, and surgery.<ref name=NIH2012What/> Effective lifestyle changes may include avoiding [[alcohol (drug)|alcohol]], losing weight, stopping [[smoking]], and sleeping on one's side.<ref name=Gottlieb&2020>((cite journal|last1=Gottlieb|first1=Daniel J.|last2=Punjabi|first2=Naresh M.|date=14 April 2020|title=Diagnosis and Management of Obstructive Sleep Apnea: A Review|url=https://doi.org/10.1001/jama.2020.3514|journal=JAMA|volume=323|issue=14|pages=1389–1400|doi=10.1001/jama.2020.3514|pmid=32286648 |s2cid=215759986 |issn=0098-7484|url-access=subscription))</ref> Breathing devices include the use of a [[Continuous positive airway pressure|CPAP machine]].<ref name=NIH2012Tx>((cite web|title=How Is Sleep Apnea Treated?|url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/treatment|website=NHLBI|access-date=18 August 2016|date=10 July 2012|url-status=live|archive-url=https://web.archive.org/web/20160827160600/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/treatment|archive-date=27 August 2016))</ref> With proper use, CPAP improves outcomes.<ref name=Spi2015/> Evidence suggests that CPAP may improve sensitivity to insulin, blood pressure, and sleepiness.<ref>((cite journal | vauthors = Iftikhar IH, Khan MF, Das A, Magalang UJ | title = Meta-analysis: continuous positive airway pressure improves insulin resistance in patients with sleep apnea without diabetes | journal = Annals of the American Thoracic Society | volume = 10 | issue = 2 | pages = 115–20 | date = April 2013 | pmid = 23607839 | pmc = 3960898 | doi = 10.1513/annalsats.201209-081oc ))</ref><ref>((cite journal | vauthors = Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A, Velkeniers B | title = The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials | journal = Archives of Internal Medicine | volume = 167 | issue = 8 | pages = 757–64 | date = April 2007 | pmid = 17452537 | doi = 10.1001/archinte.167.8.757 | doi-access =  ))</ref><ref>((cite journal | vauthors = Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT | title = Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis | journal = Archives of Internal Medicine | volume = 163 | issue = 5 | pages = 565–71 | date = March 2003 | pmid = 12622603 | doi = 10.1001/archinte.163.5.565 | doi-access =  ))</ref> Long term compliance, however, is an issue with more than half of people not appropriately using the device.<ref name=Spi2015>((cite journal | vauthors = Spicuzza L, Caruso D, Di Maria G | title = Obstructive sleep apnoea syndrome and its management | journal = Therapeutic Advances in Chronic Disease | volume = 6 | issue = 5 | pages = 273–85 | date = September 2015 | pmid = 26336596 | pmc = 4549693 | doi = 10.1177/2040622315590318 ))</ref><ref name="Hsu2003">((cite journal | vauthors = Hsu AA, Lo C | title = Continuous positive airway pressure therapy in sleep apnoea | journal = Respirology | volume = 8 | issue = 4 | pages = 447–54 | date = December 2003 | pmid = 14708553 | doi = 10.1046/j.1440-1843.2003.00494.x | doi-access = free ))</ref> In 2017, only 15% of potential patients in developed countries used CPAP machines, while in developing countries well under 1% of potential patients used CPAP.<ref>((cite web|url=https://www.fool.com/investing/2017/11/18/3-top-medical-device-stocks-to-buy-now.aspx|title = 3 Top Medical Device Stocks to Buy Now|date = 18 November 2017))</ref> Without treatment, sleep apnea may increase the risk of [[myocardial infarction|heart attack]], [[stroke]], [[diabetes]], [[heart failure]], [[irregular heartbeat]], [[obesity]], and [[motor vehicle collisions]].<ref name=NIH2012What/>

[[Alzheimer's disease]] and severe obstructive sleep apnea are connected<ref name="ReferenceB">((cite journal|pmc = 6542637|year = 2018|last1 = Andrade|first1 = A.|last2 = Bubu|first2 = O. M.|last3 = Varga|first3 = A. W.|last4 = Osorio|first4 = R. S.|title = The relationship between Obstructive Sleep Apnea and Alzheimer's Disease|journal = Journal of Alzheimer's Disease|volume = 64|issue = Suppl 1|pages = S255–S270|doi = 10.3233/JAD-179936|pmid = 29782319))</ref> because there is an increase in the protein [[beta-amyloid]] as well as [[White matter|white-matter]] damage.  These are the main indicators of Alzheimer's, which in this case comes from the lack of proper rest or poorer sleep efficiency resulting in [[neurodegeneration]].<ref name="Jackson et al 2020"/><ref name="Weihs Frenzel Grabe 2021 pp. 87–96">((cite journal | last1=Weihs | first1=Antoine | last2=Frenzel | first2=Stefan | last3=Grabe | first3=Hans J. | title=The Link Between Obstructive Sleep Apnoea and Neurodegeneration and Cognition | journal=Current Sleep Medicine Reports | publisher=Springer Science and Business Media LLC | volume=7 | issue=3 | date=13 July 2021 | issn=2198-6401 | doi=10.1007/s40675-021-00210-5 | pages=87–96| s2cid=235801219 | doi-access=free | url=https://pub.dzne.de/record/155442/files/19530.pdf ))</ref><ref>((cite journal |last1=Lee |first1=Min-Hee |last2=Lee |first2=Seung Ku |last3=Kim |first3=Soriul |last4=Kim |first4=Regina E. Y. |last5=Nam |first5=Hye Ryeong |last6=Siddiquee |first6=Ali T. |last7=Thomas |first7=Robert J. |last8=Hwang |first8=Inha |last9=Yoon |first9=Jee-Eun |last10=Yun |first10=Chang-Ho |last11=Shin |first11=Chol |title=Association of Obstructive Sleep Apnea With White Matter Integrity and Cognitive Performance Over a 4-Year Period in Middle to Late Adulthood |url=https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794441 |journal=[[JAMA Network Open]] |access-date=28 June 2023 |doi=10.1001/jamanetworkopen.2022.22999 |date=20 July 2022|volume=5 |issue=7 |pages=e2222999 |pmid=35857321 |pmc=9301517 ))</ref> Having sleep apnea in mid-life brings a higher likelihood of developing Alzheimer's in older age, and if one has Alzheimer's then one is also more likely to have sleep apnea.<ref name="Owen et al 2020"/> This is demonstrated by cases of sleep apnea even being misdiagnosed as [[dementia]].<ref>((cite web|url=https://newoldage.blogs.nytimes.com/2010/10/06/when-sleep-apnea-masquerades-as-dementia/|title = When Sleep Apnea Masquerades as Dementia|date = 6 October 2010))</ref> With the use of treatment through CPAP, there is a reversible risk factor in terms of the amyloid proteins.  This usually restores brain structure and diminishes cognitive impairment.<ref>((cite journal |last1=Liguori |first1=Claudio |last2=Chiaravalloti |first2=Agostino |last3=Izzi |first3=Francesca |last4=Nuccetelli |first4=Marzia |last5=Bernardini |first5=Sergio |last6=Schillaci |first6=Orazio |last7=Mercuri |first7=Nicola Biagio |last8=Placidi |first8=Fabio |title=Sleep apnoeas may represent a reversible risk factor for amyloid-β pathology |journal=Brain |date=1 December 2017 |volume=140 |issue=12 |pages=e75 |doi=10.1093/brain/awx281 |pmid=29077794 |doi-access=free ))</ref><ref>((cite journal |last1=Castronovo |first1=Vincenza |last2=Scifo |first2=Paola |last3=Castellano |first3=Antonella |last4=Aloia |first4=Mark S. |last5=Iadanza |first5=Antonella |last6=Marelli |first6=Sara |last7=Cappa |first7=Stefano F. |last8=Strambi |first8=Luigi Ferini |last9=Falini |first9=Andrea |title=White Matter Integrity in Obstructive Sleep Apnea before and after Treatment |journal=Sleep |date=1 September 2014 |volume=37 |issue=9 |pages=1465–1475 |doi=10.5665/sleep.3994 |pmid=25142557 |pmc=4153061 |url=https://aasm.org/brain-damage-caused-by-severe-sleep-apnea-is-reversible/ ))</ref><ref name="Cooke Ayalon Palmer Loredo 2009 pp. 305–309">((cite journal | last1=Cooke | first1=Jana R. | last2=Ayalon | first2=Liat | last3=Palmer | first3=Barton W. | last4=Loredo | first4=Jose S. | last5=Corey-Bloom | first5=Jody | last6=Natarajan | first6=Loki | last7=Liu | first7=Lianqi | last8=Ancoli-Israel | first8=Sonia | title=Sustained Use of CPAP Slows Deterioration of Cognition, Sleep, and Mood in Patients with Alzheimer's Disease and Obstructive Sleep Apnea: A Preliminary Study | journal=Journal of Clinical Sleep Medicine | publisher=American Academy of Sleep Medicine (AASM) | volume=05 | issue=4 | date=15 August 2009 | issn=1550-9389 | doi=10.5664/jcsm.27538 | pages=305–309| s2cid=24123888 | doi-access=free ))</ref>

<!-- Epidemiology and culture -->
OSA is a common sleep disorder. A large analysis in 2019 of the estimated prevalence of OSA found that OSA affects 936 million—1 billion people between the ages of 30–69 globally, or roughly every 1 in 10 people, and up to 30% of the elderly.<ref>((cite journal|last1=Franklin|first1=Karl A.|last2=Lindberg|first2=Eva|date=August 2015|title=Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea|journal=Journal of Thoracic Disease|volume=7|issue=8|pages=1311–1322|doi=10.3978/j.issn.2072-1439.2015.06.11|issn=2072-1439|pmc=4561280|pmid=26380759))</ref> Sleep apnea is somewhat more common in men than women, roughly a 2:1 ratio of men to women, and in general more people are likely to have it with older age and obesity.<ref name="ReferenceC"/>

==Signs and symptoms==
People with sleep apnea have problems with [[excessive daytime sleepiness]] (EDS) and impaired alertness.<ref name="elad">((cite journal | vauthors = El-Ad B, Lavie P | title = Effect of sleep apnea on cognition and mood | journal = International Review of Psychiatry | volume = 17 | issue = 4 | pages = 277–82 | date = August 2005 | pmid = 16194800 | doi = 10.1080/09540260500104508 | s2cid = 7527654 ))</ref> OSA may increase risk for driving accidents and work-related accidents. If OSA is not treated, people are at increased risk of other health problems, such as diabetes.((medical citation needed|data=February 2024|date=February 2024))

Due to the disruption in daytime cognitive state, behavioral effects may be present. These can include moodiness, belligerence, as well as a decrease in attentiveness and energy.<ref name="aloiaetal" /> These effects may become intractable, leading to depression.<ref>((cite journal | vauthors = Sculthorpe LD, Douglass AB | title = Sleep pathologies in depression and the clinical utility of polysomnography | journal = Canadian Journal of Psychiatry | volume = 55 | issue = 7 | pages = 413–21 | date = July 2010 | pmid = 20704768 | doi = 10.1177/070674371005500704 | doi-access = free | url = https://nrc-publications.canada.ca/eng/view/accepted/?id=31e80401-0de8-408d-90c5-1a593b660ea8 ))</ref>

There is evidence that the risk of diabetes among those with moderate or severe sleep apnea is higher.<ref name="pmid24582098">((cite journal | vauthors = Morgenstern M, Wang J, Beatty N, Batemarco T, Sica AL, Greenberg H | title = Obstructive sleep apnea: an unexpected cause of insulin resistance and diabetes | journal = Endocrinology and Metabolism Clinics of North America | volume = 43 | issue = 1 | pages = 187–204 | date = March 2014 | pmid = 24582098 | doi = 10.1016/j.ecl.2013.09.002 ))</ref> Finally, because there are many factors that could lead to some of the effects previously listed, some people are not aware that they have sleep apnea and are either misdiagnosed or ignore the symptoms altogether.<ref name="elad" />

==Risk factors==
Sleep apnea can affect people regardless of sex, race, or age.<ref>((cite journal | url=https://www.ccjm.org/content/86/9_suppl_1/2 | pmid=31509498 | date=2019 | title=Obstructive sleep apnea basics | journal=Cleveland Clinic Journal of Medicine | volume=86 | issue=9 Suppl 1 | pages=2–9 | doi=10.3949/ccjm.86.s1.02 | vauthors = Rundo JV | doi-access=free ))</ref> However, risk factors include:<ref name="nhlbi">((cite web | url=https://www.nhlbi.nih.gov/health/sleep-apnea/causes | title=Sleep Apnea - Causes and Risk Factors &#124; NHLBI, NIH | date=24 March 2022 ))</ref>
* male gender,<ref name="nhlbi"/><ref name="sleep.hms.harvard.edu"/>
* obesity,<ref name="nhlbi"/><ref name="sleep.hms.harvard.edu"/>
* age<ref name="nhlbi"/> over 40((medical citation needed|date=February 2024))
* large neck circumference,<ref name="nhlbi"/> (greater than 16–17 inches)((medical citation needed|date=February 2024))
* enlarged tonsils or tongue,<ref name="nhlbi"/>
* narrow upper jaw,((medical citation needed|date=February 2024))
* small lower jaw,<ref name="sleep.hms.harvard.edu">((cite web | url=https://sleep.hms.harvard.edu/education-training/public-education/sleep-and-health-education-program/sleep-health-education-25 | title=Risk Factors ))</ref>
* receding chin,((medical citation needed|date=February 2024))
* nasal congestion,((medical citation needed|date=February 2024))
* allergies,((medical citation needed|date=February 2024))
* [[Gastroesophageal reflux disease|gastroesophageal reflux]],
* a family history of sleep apnea, or genetics,<ref name="nhlbi"/>
* endocrine disorders<ref name="nhlbi"/> such as hypothyroidism,<ref name="sleep.hms.harvard.edu"/>
* heart or kidney failure,<ref name="nhlbi"/>
* lifestyle habits such as smoking or drinking alcohol.<ref name="nhlbi"/>

Alcohol, sedatives and tranquilizers may also promote sleep apnea by relaxing throat muscles. People who smoke tobacco have sleep apnea at three times the rate of people who have never done so.<ref name=Mayo>((cite news|last=Mayo Clinic|title=Sleep apnea|website=[[Mayo Clinic]]|url=http://www.mayoclinic.org/diseases-conditions/sleep-apnea/basics/risk-factors/con-20020286|url-status=live|archive-url=https://web.archive.org/web/20140430014314/http://www.mayoclinic.org/diseases-conditions/sleep-apnea/basics/risk-factors/con-20020286|archive-date=30 April 2014))</ref>

Central sleep apnea is more often associated with any of the following risk factors:((medical citation needed|data=February 2024|date=February 2024))
* being male((medical citation needed|data=February 2024|date=February 2024))
* an age above 65((medical citation needed|data=February 2024|date=February 2024))
* having heart disorders such as [[atrial fibrillation]] or [[Atrial septal defect#Patent foramen ovale|atrial septal defects such as PFO]]((medical citation needed|data=February 2024|date=February 2024))
* stroke((medical citation needed|data=February 2024|date=February 2024))

[[Hypertension|High blood pressure]] is very common in people with sleep apnea.<ref>((cite news| url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/atrisk| title=What Is Sleep Apnea?| work=Nhlbi health| url-status=live| archive-url=https://web.archive.org/web/20150820140400/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/atrisk| archive-date=20 August 2015))</ref>

==Mechanism==
When breathing is paused, carbon dioxide builds up in the bloodstream. [[Chemoreceptor]]s in the bloodstream note the high carbon dioxide levels. The brain is signaled to awaken the person, which clears the airway and allows breathing to resume. Breathing normally will restore oxygen levels and the person will fall asleep again.<ref>((cite book|last=Green|first=Simon|title=Biological Rhythms, Sleep and Hyponosis|date=8 February 2011|publisher=Palgrave Macmillan|location=England|isbn=978-0-230-25265-3|page=85))</ref> This carbon dioxide build-up may be due to the decrease of output of the brainstem regulating the chest wall or pharyngeal muscles, which causes the pharynx to collapse.<ref name=Pur2018/> People with sleep apnea experience reduced or no [[slow-wave sleep]] and spend less time in [[REM sleep]].<ref name=Pur2018>((cite book|title=Neuroscience|last=Purves|first=Dale|isbn=978-1-60535-380-7 |publisher=Oxford University Press |edition=Sixth|location=New York|oclc=990257568|date = 4 July 2018))((page needed|date=March 2021))</ref>

== Complications ==
OSA is a serious medical condition. Daytime fatigue and sleepiness, cardiovascular problems and eye problems are considered potential complications of OSA. OSA may also be a risk factor of [[COVID-19]]. People with OSA have a higher risk of developing severe complications of COVID-19.<ref>((cite web |title=Obstructive sleep apnea - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090 |access-date=30 March 2022 |website=Mayo Clinic |language=en))</ref>

==Diagnosis==

Despite this((Which|date=February 2021)) medical consensus, the variety of apneic events (e.g., hypopnea vs apnea, central vs obstructive), the variability of patients' physiologies, and the inherent shortcomings and variability of equipment and methods, this field is subject to debate.<ref>((cite journal | vauthors = Redline S, Budhiraja R, Kapur V, Marcus CL, Mateika JH, Mehra R, Parthasarthy S, Somers VK, Strohl KP, Sulit LG, Gozal D, Wise MS, Quan SF | title = The scoring of respiratory events in sleep: reliability and validity | journal = Journal of Clinical Sleep Medicine | volume = 3 | issue = 2 | pages = 169–200 | date = March 2007 | pmid = 17557426 | doi = 10.5664/jcsm.26818 | doi-access = free ))</ref>
Within this context, the definition of an event depends on several factors (e.g., patient's age) and account for this variability through a multi-criteria decision rule described in several, sometimes conflicting, guidelines.<ref>((cite journal | author = AASM Task Force | title = Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force | journal = Sleep | volume = 22 | issue = 5 | pages = 667–89 | date = August 1999 | pmid = 10450601 | doi = 10.1093/sleep/22.5.667 | doi-access = free ))</ref><ref>((cite journal | vauthors = Ruehland WR, Rochford PD, O'Donoghue FJ, Pierce RJ, Singh P, Thornton AT | title = The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index | journal = Sleep | volume = 32 | issue = 2 | pages = 150–7 | date = February 2009 | pmid = 19238801 | pmc = 2635578 | doi = 10.1093/sleep/32.2.150 ))</ref>

===Oximetry===
[[Oximetry]], which may be performed over one or several nights in a person's home, is a simpler, but less reliable alternative to a [[polysomnography]]. The test is recommended only when requested by a physician and should not be used to test those without symptoms.<ref>((cite web|title=AASM releases position statement on home sleep apnea testing&nbsp;– American Academy of Sleep Medicine&nbsp;– Association for Sleep Clinicians and Researchers|url=https://aasm.org/aasm-releases-position-statement-home-sleep-apnea-testing/|website=aasm.org|access-date=18 October 2017|date=13 October 2017))</ref> Home oximetry may be effective in guiding prescription for automatically self-adjusting [[continuous positive airway pressure]].<ref name="pmid15486338">((cite journal |last1=Whitelaw |first1=William A. |last2=Brant |first2=Rollin F. |last3=Flemons |first3=W. Ward |title=Clinical Usefulness of Home Oximetry Compared with Polysomnography for Assessment of Sleep Apnea |journal=American Journal of Respiratory and Critical Care Medicine |date=15 January 2005 |volume=171 |issue=2 |pages=188–193 |doi=10.1164/rccm.200310-1360OC |pmid=15486338 |s2cid=26015566 ))</ref><ref>((cite journal | vauthors = Caples SM | title = The accuracy of physicians in predicting successful treatment response in suspected obstructive sleep apnea did not differ between home monitoring and polysomnography | journal = ACP Journal Club | volume = 143 | issue = 1 | pages = 21 | year = 2005 | doi = 10.7326/ACPJC-2005-143-1-021 | pmid = 15989309 | s2cid = 219673066 ))</ref>

===Classification===
There are three types of sleep apnea. OSA accounts for 84%, CSA for 0.9%, and 15% of cases are mixed.<ref>((cite journal |last1=Morgenthaler |first1=Timothy I. |last2=Kagramanov |first2=Vadim |last3=Hanak |first3=Viktor |last4=Decker |first4=Paul A. |title=Complex Sleep Apnea Syndrome: Is It a Unique Clinical Syndrome? |journal=Sleep |date=September 2006 |volume=29 |issue=9 |pages=1203–1209 |doi=10.1093/sleep/29.9.1203 |pmid=17040008 |url=https://www.sciencedaily.com/releases/2006/09/060901161349.htm |doi-access=free ))</ref>

====Obstructive sleep apnea====
((Main|Obstructive sleep apnea))
[[File:ObstructiveApnea.png|thumb|upright=1.3|Screenshot of a PSG system showing an obstructive apnea]]
[[File:New no obstruction.png|thumb|No airway obstruction during sleep]]
[[File:Airway obstruction.png|thumb|Airway obstruction during sleep]]
Obstructive sleep apnea (OSA) is the most common category of sleep-disordered breathing. The muscle tone of the body ordinarily relaxes during sleep, and at the level of the throat, the human airway is composed of collapsible walls of soft tissue that can obstruct breathing. Mild occasional sleep apnea, such as many people experience during an [[upper respiratory infection]], may not be significant, but chronic severe obstructive sleep apnea requires treatment to prevent low blood oxygen ([[hypoxemia]]), [[sleep deprivation]], and other complications.((medical citation needed|data=February 2024|date=February 2024))

Individuals with low muscle-tone and soft tissue around the airway (e.g., because of obesity) and structural features that give rise to a narrowed airway are at high risk for obstructive sleep apnea. The elderly are more likely to have OSA than young people. Men are more likely to develop sleep apnea than women and children are, though it is not uncommon in the last two population groups.<ref>((cite web | url = http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhoIsAtRisk.html | title = Sleep Apnea: Who Is At Risk for Sleep Apnea? | work = NHLBI: Health Information for the Public | publisher = U.S. Department of Health and Human Services | url-status = live | archive-url = https://web.archive.org/web/20100721082753/http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhoIsAtRisk.html | archive-date = 21 July 2010 ))</ref>

The risk of OSA rises with increasing body weight, active smoking and age. In addition, patients with diabetes or "borderline" diabetes have up to three times the risk of having OSA.((medical citation needed|data=February 2024|date=February 2024))

Common symptoms include loud [[snoring]], restless sleep, and sleepiness during the daytime. Diagnostic tests include home [[oximetry]] or [[polysomnography]] in a sleep clinic.((medical citation needed|data=February 2024|date=February 2024))

Some treatments involve lifestyle changes, such as avoiding alcohol or muscle relaxants, losing weight, and quitting smoking. Many people benefit from sleeping at a 30-degree elevation of the upper body<ref>((cite journal | vauthors = Neill AM, Angus SM, Sajkov D, McEvoy RD | title = Effects of sleep posture on upper airway stability in patients with sleep apnea | journal = American Journal of Respiratory and Critical Care Medicine | volume = 155 | issue = 1 | pages = 199–204 | date = January 1997 | pmid = 9001312 | doi = 10.1164/ajrccm.155.1.9001312 ))</ref> or higher, as if in a [[recliner]]. Doing so helps prevent the gravitational collapse of the airway. [[Human anatomical terms#Anatomical directions|Lateral positions]] (sleeping on a side), as opposed to [[supine position]]s (sleeping on the back), are also recommended as a treatment for sleep apnea,<ref>((cite web |first1=Guo |last1=Xiheng |first2=Wang |last2=Chen |first3=Zhang |last3=Hongyu |first4=Kong |last4=Weimin |first5=An |last5=Li |first6=Liu |last6=Li |first7=Weng |last7=Xinzhi |year=2003 |title=The Study Of The Influence Of Sleep Position On Sleep Apnea |publisher=[[Cardinal Health]] |citeseerx=10.1.1.123.406 ))</ref><ref>((cite journal | vauthors = Loord H, Hultcrantz E | title = Positioner--a method for preventing sleep apnea | journal = Acta Oto-Laryngologica | volume = 127 | issue = 8 | pages = 861–8 | date = August 2007 | pmid = 17762999 | doi = 10.1080/00016480601089390 | s2cid = 323418 ))</ref><ref name=pmid16944673>((cite journal |last1=Szollosi |first1=Irene |last2=Roebuck |first2=Teanau |last3=Thompson |first3=Bruce |last4=Naughton |first4=Matthew T |title=Lateral Sleeping Position Reduces Severity of Central Sleep Apnea / Cheyne-Stokes Respiration |journal=Sleep |date=August 2006 |volume=29 |issue=8 |pages=1045–1051 |doi=10.1093/sleep/29.8.1045 |pmid=16944673 |doi-access=free ))</ref> largely because the gravitational component is smaller in the lateral position. Some people benefit from various kinds of oral appliances such as the [[Mandibular advancement splint]] to keep the airway open during sleep. [[Continuous positive airway pressure]] (CPAP) is the most effective treatment for severe obstructive sleep apnea, but oral appliances are considered a first-line approach equal to CPAP for mild to moderate sleep apnea, according to the American Academy of Sleep Medicine (AASM) parameters of care.<ref>((cite journal | vauthors = Vennelle M, White S, Riha RL, Mackay TW, Engleman HM, Douglas NJ | title = Randomized controlled trial of variable-pressure versus fixed-pressure continuous positive airway pressure (CPAP) treatment for patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) | journal = Sleep | volume = 33 | issue = 2 | pages = 267–71 | date = February 2010 | pmid = 20175411 | pmc = 2817914 | doi = 10.1093/sleep/33.2.267 ))</ref> There are also surgical procedures to remove and tighten tissue and widen the airway.((medical citation needed|data=February 2024|date=February 2024))

Snoring is a common finding in people with this syndrome. Snoring is the turbulent sound of air moving through the back of the mouth, nose, and throat. Although not everyone who snores is experiencing difficulty breathing, snoring in combination with other risk factors has been found to be highly predictive of OSA.<ref name="snoring">((cite journal | vauthors = Morris LG, Kleinberger A, Lee KC, Liberatore LA, Burschtin O | title = Rapid risk stratification for obstructive sleep apnea, based on snoring severity and body mass index | journal = Otolaryngology–Head and Neck Surgery | volume = 139 | issue = 5 | pages = 615–8 | date = November 2008 | pmid = 18984252 | doi = 10.1016/j.otohns.2008.08.026 | s2cid = 5851919 ))</ref> The loudness of the snoring is not indicative of the severity of obstruction, however. If the upper airways are tremendously obstructed, there may not be enough air movement to make much sound. Even the loudest snoring does not mean that an individual has sleep apnea syndrome. The sign that is most suggestive of sleep apneas occurs when snoring ''stops''.((medical citation needed|data=February 2024|date=February 2024))

Up to 78% of genes associated with habitual snoring also increase the risk for OSA.<ref>((cite journal |last1=Campos |first1=Adrián I. |last2=García-Marín |first2=Luis M. |last3=Byrne |first3=Enda M. |last4=Martin |first4=Nicholas G. |last5=Cuéllar-Partida |first5=Gabriel |last6=Rentería |first6=Miguel E. |title=Insights into the aetiology of snoring from observational and genetic investigations in the UK Biobank |journal=Nature Communications |date=December 2020 |volume=11 |issue=1 |pages=817 |doi=10.1038/s41467-020-14625-1 |pmid=32060260 |pmc=7021827 |bibcode=2020NatCo..11..817C ))</ref>

Other indicators include (but are not limited to): [[hypersomnolence]], obesity (BMI ≥ 30), large neck circumference—((Convert|16|in|abbr=on)) in women, ((Convert|17|in|abbr=on)) in men — enlarged tonsils and large tongue volume, [[micrognathia]], morning headaches, irritability/mood-swings/depression, learning and/or memory difficulties, and sexual dysfunction.

The term "sleep-disordered breathing" is commonly used in the U.S. to describe the full range of breathing problems during sleep in which not enough air reaches the lungs ([[hypopnea]] and apnea). Sleep-disordered breathing is associated with an increased risk of [[cardiovascular disease]], [[stroke]], [[high blood pressure]], [[arrhythmias]], [[diabetes]], and [[sleep deprived driving]] accidents.<ref name="Arrhythmias">((cite journal | vauthors = Yan-fang S, Yu-ping W | title = Sleep-disordered breathing: impact on functional outcome of ischemic stroke patients | journal = Sleep Medicine | volume = 10 | issue = 7 | pages = 717–9 | date = August 2009 | pmid = 19168390 | doi = 10.1016/j.sleep.2008.08.006 ))</ref><ref name="hypertension children">((cite journal | vauthors = Bixler EO, Vgontzas AN, Lin HM, Liao D, Calhoun S, Fedok F, Vlasic V, Graff G | title = Blood pressure associated with sleep-disordered breathing in a population sample of children | journal = Hypertension | volume = 52 | issue = 5 | pages = 841–6 | date = November 2008 | pmid = 18838624 | pmc = 3597109 | doi = 10.1161/HYPERTENSIONAHA.108.116756 ))</ref><ref name="stroke">((cite journal | vauthors = Leung RS | title = Sleep-disordered breathing: autonomic mechanisms and arrhythmias | journal = Progress in Cardiovascular Diseases | volume = 51 | issue = 4 | pages = 324–38 | year = 2009 | pmid = 19110134 | doi = 10.1016/j.pcad.2008.06.002 ))</ref><ref name="HBP">((cite journal | vauthors = Silverberg DS, Iaina A, Oksenberg A | title = Treating obstructive sleep apnea improves essential hypertension and quality of life | journal = American Family Physician | volume = 65 | issue = 2 | pages = 229–36 | date = January 2002 | pmid = 11820487 | url = http://www.aafp.org/afp/20020115/229.html | archive-url = https://web.archive.org/web/20080513213722/http://www.aafp.org/afp/20020115/229.html | url-status = live | archive-date = 13 May 2008 ))</ref> When high blood pressure is caused by OSA, it is distinctive in that, unlike most cases of high blood pressure (so-called [[essential hypertension]]), the readings do ''not'' drop significantly when the individual is sleeping.<ref>((cite journal | vauthors = Grigg-Damberger M | title = Why a polysomnogram should become part of the diagnostic evaluation of stroke and transient ischemic attack | journal = Journal of Clinical Neurophysiology | volume = 23 | issue = 1 | pages = 21–38 | date = February 2006 | pmid = 16514349 | doi = 10.1097/01.wnp.0000201077.44102.80 | s2cid = 19626174 ))</ref> [[Stroke]] is associated with obstructive sleep apnea.<ref>((cite journal |last1=Yaggi |first1=H. Klar |last2=Concato |first2=John |last3=Kernan |first3=Walter N. |last4=Lichtman |first4=Judith H. |last5=Brass |first5=Lawrence M. |last6=Mohsenin |first6=Vahid |title=Obstructive Sleep Apnea as a Risk Factor for Stroke and Death |journal=New England Journal of Medicine |date=10 November 2005 |volume=353 |issue=19 |pages=2034–2041 |doi=10.1056/NEJMoa043104 |pmid=16282178 |s2cid=23360654 |doi-access=free ))</ref>

Obstructive sleep apnea is associated with problems in daytime functioning, such as daytime sleepiness, motor vehicle crashes, psychological problems, decreased cognitive functioning, and reduced quality of life.<ref name=Young2004>((cite journal |last1=Young |first1=Terry |title=Risk Factors for Obstructive Sleep Apnea in Adults |journal=JAMA |date=28 April 2004 |volume=291 |issue=16 |pages=2013–6 |doi=10.1001/jama.291.16.2013|pmid=15113821 |s2cid=12315855 ))</ref> Other associated problems include cerebrovascular diseases (hypertension, coronary artery disease, and stroke) and diabetes.<ref name=Young2004/> These problems could be, at least in part, caused by risk factors of OSA.<ref name=Young2004/>

====Central sleep apnea====
((More citations needed|date=May 2010))
((Main|Central sleep apnea))
[[File:CentralApnea.png|thumb|upright=1.3|Screenshot of a PSG system showing a central apnea]]
In pure central sleep apnea or [[Cheyne–Stokes respiration]], the brain's respiratory control centers are imbalanced during sleep.<ref>((cite journal | vauthors = Yumino D, Bradley TD | title = Central sleep apnea and Cheyne-Stokes respiration | journal = Proceedings of the American Thoracic Society | volume = 5 | issue = 2 | pages = 226–36 | date = February 2008 | pmid = 18250216 | doi = 10.1513/pats.200708-129MG ))</ref> Blood levels of carbon dioxide, and the neurological feedback mechanism that monitors them, do not react quickly enough to maintain an even respiratory rate, with the entire system cycling between apnea and tachypnea, even during wakefulness. The sleeper stops breathing and then starts again. There is no effort made to breathe during the pause in breathing: there are no chest movements and no struggling. After the episode of apnea, breathing may be faster (tachypnea) for a period of time, a compensatory mechanism to blow off retained waste gases and absorb more oxygen.((medical citation needed|data=February 2024|date=February 2024))

While sleeping, a normal individual is "at rest" as far as cardiovascular workload is concerned. Breathing is regular in a healthy person during sleep, and oxygen levels and carbon dioxide levels in the bloodstream stay fairly constant. Any sudden drop in oxygen or excess of carbon dioxide (even if tiny) strongly stimulates the brain's respiratory centers to breathe.((medical citation needed|data=February 2024|date=February 2024))

In any person, hypoxia and hypercapnia have certain common effects on the body.<ref>((cite journal | vauthors = Sicard KM, Duong TQ | title = Effects of hypoxia, hyperoxia, and hypercapnia on baseline and stimulus-evoked BOLD, CBF, and CMRO2 in spontaneously breathing animals | journal = [[NeuroImage]] | volume = 25 | issue = 3 | pages = 850–8 | date = April 2005 | pmid = 15808985 | pmc = 2962945 | doi = 10.1016/j.neuroimage.2004.12.010 ))</ref> The heart rate will increase, unless there are such severe co-existing problems with the heart muscle itself or the autonomic nervous system that makes this compensatory increase impossible. The more translucent areas of the body will show a bluish or dusky cast from [[cyanosis]], which is the change in hue that occurs owing to lack of oxygen in the blood ("turning blue"). Overdoses of drugs that are respiratory depressants (such as heroin, and other opiates) kill by damping the activity of the brain's respiratory control centers. In central sleep apnea, the effects of sleep ''alone'' can remove the brain's mandate for the body to breathe.
* Normal Respiratory Drive: After exhalation, the blood level of oxygen decreases and that of carbon dioxide increases. Exchange of gases with a lungful of fresh air is necessary to replenish oxygen and rid the bloodstream of built-up carbon dioxide. Oxygen and carbon dioxide receptors in the blood stream (called [[chemoreceptors]]) send nerve impulses to the brain, which then signals reflex opening of the [[larynx]] (so that the opening between the vocal cords enlarges) and movements of the rib cage muscles and [[Diaphragm (anatomy)|diaphragm]]. These muscles expand the [[Human thorax|thorax]] (chest cavity) so that a partial vacuum is made within the lungs and air rushes in to fill it.
* Physiologic effects of central apnea: During central apneas, the central respiratory drive is absent, and the brain does ''not'' respond to changing blood levels of the respiratory gases. No breath is taken despite the normal signals to inhale. The immediate effects of central sleep apnea on the body depend on how long the failure to breathe endures. At worst, central sleep apnea may cause sudden death. Short of death, drops in blood oxygen may trigger [[seizure]]s, even in the absence of [[epilepsy]]. In people ''with'' epilepsy, the hypoxia caused by apnea may trigger seizures that had previously been well controlled by medications.<ref name="Epilepsy and sleep apnea syndrome">((cite journal | vauthors = Devinsky O, Ehrenberg B, Barthlen GM, Abramson HS, Luciano D | title = Epilepsy and sleep apnea syndrome | journal = Neurology | volume = 44 | issue = 11 | pages = 2060–4 | date = November 1994 | pmid = 7969960 | doi = 10.1212/WNL.44.11.2060 | s2cid = 2165184 ))</ref> In other words, a seizure disorder may become unstable in the presence of sleep apnea. In adults with [[coronary artery disease]], a severe drop in blood oxygen level can cause [[angina]], [[Heart arrhythmia|arrhythmia]]s, or heart attacks ([[myocardial infarction]]). Longstanding recurrent episodes of apnea, over months and years, may cause an increase in carbon dioxide levels that can change the pH of the blood enough to cause a [[respiratory acidosis]].((medical citation needed|data=February 2024|date=February 2024))

====Mixed apnea====
Some people with sleep apnea have a combination of both types; its prevalence ranges from 0.56% to 18%. The condition is generally detected when obstructive sleep apnea is treated with CPAP and central sleep apnea emerges. The exact mechanism of the loss of central respiratory drive during sleep in OSA is unknown but is most likely related to incorrect settings of the CPAP treatment and other medical conditions the person has.<ref name= ComplexRev2014>((cite journal | vauthors = Khan MT, Franco RA | title = Complex sleep apnea syndrome | journal = Sleep Disorders | volume = 2014 | pages = 1–6 | year = 2014 | pmid = 24693440 | pmc = 3945285 | doi = 10.1155/2014/798487 | doi-access = free ))</ref>

==Management==
The treatment of obstructive sleep apnea is different than that of central sleep apnea. Treatment often starts with behavioral therapy and some people may be suggested to try a [[continuous positive airway pressure]] device. Many people are told to avoid alcohol, sleeping pills, and other sedatives, which can relax throat muscles, contributing to the collapse of the airway at night.<ref name=SleepApneaTreatments /> The evidence supporting one treatment option compared to another for a particular person is not clear.<ref name="pmid36278514">((cite journal |last1=Pinto |first1=Ana Carolina Pereira Nunes |last2=Rocha |first2=Aline |last3=Drager |first3=Luciano F |last4=Lorenzi-Filho |first4=Geraldo |last5=Pachito |first5=Daniela V |date=24 October 2022 |editor-last=Cochrane Airways Group |title=Non-invasive positive pressure ventilation for central sleep apnoea in adults |url= |journal=Cochrane Database of Systematic Reviews |language=en |volume=2022 |issue=10 |pages=CD012889 |doi=10.1002/14651858.CD012889.pub2 |pmc=9590003 |pmid=36278514 ))</ref>

=== Changing sleep position ===
More than half of people with obstructive sleep apnea have some degree of positional obstructive sleep apnea, meaning that it gets worse when they sleep on their backs.<ref name="pmid28852945">((cite journal |last1=Omobomi |first1=Olabimpe |last2=Quan |first2=Stuart F. |date=May 2018 |title=Positional therapy in the management of positional obstructive sleep apnea-a review of the current literature |url=https://dash.harvard.edu/bitstream/1/35427798/1/2017%20Omobomi%20and%20Quan%2c%20Positional%20therapy....pdf |journal=Sleep & Breathing = Schlaf & Atmung |volume=22 |issue=2 |pages=297–304 |doi=10.1007/s11325-017-1561-y |issn=1522-1709 |pmid=28852945|s2cid=4038428 ))</ref>  Sleeping on their sides is an effective and cost-effective treatment for positional obstructive sleep apnea.<ref name="pmid28852945" />

===Continuous positive airway pressure===
[[File:Cpapanwender.jpg|thumb|Person using a CPAP mask, covering only the nose]]
[[File:CPAP-machine-resmedS9.jpg|thumb|CPAP machine with two models of masks]]
((see also|Continuous positive airway pressure))
For moderate to severe sleep apnea, the most common treatment is the use of a [[Positive airway pressure#Continuous pressure devices|continuous positive airway pressure]] (CPAP) or automatic positive airway pressure (APAP) device.<ref name=SleepApneaTreatments>((cite web |url=http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_Treatments.html |title=How Is Sleep Apnea Treated? |publisher=[[National Heart, Lung, and Blood Institute]] |url-status=live |archive-url=https://web.archive.org/web/20071013043521/http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_Treatments.html |archive-date=13 October 2007 ))</ref><ref name=2012review/> These splint the person's airway open during sleep by means of pressurized air. The person typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine.<ref name=SleepApneaTreatments/>

Although CPAP therapy is effective in reducing apneas and less expensive than other treatments, some people find it uncomfortable. Some complain of feeling trapped, having chest discomfort, and skin or nose irritation. Other side effects may include dry mouth, dry nose, nosebleeds, sore lips and gums.<ref name=AHRQ2011/>

Whether or not it decreases the risk of death or heart disease is controversial with some reviews finding benefit and others not.<ref name=Spi2015/><ref>((cite journal | vauthors = Yu J, Zhou Z, McEvoy RD, Anderson CS, Rodgers A, Perkovic V, Neal B | title = Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis | journal = JAMA | volume = 318 | issue = 2 | pages = 156–166 | date = July 2017 | pmid = 28697252 | pmc = 5541330 | doi = 10.1001/jama.2017.7967 ))</ref><ref name="pmid36278514" /> This variation across studies might be driven by low rates of compliance—analyses of those who use CPAP for at least four hours a night suggests a decrease in cardiovascular events.<ref>((cite journal | vauthors = Gottlieb DJ | title = Does Obstructive Sleep Apnea Treatment Reduce Cardiovascular Risk?: It Is Far Too Soon to Say | journal = JAMA | volume = 318 | issue = 2 | pages = 128–130 | date = July 2017 | pmid = 28697240 | doi = 10.1001/jama.2017.7966 ))</ref>

===Weight loss===
Excess body weight is thought to be an important cause of sleep apnea.<ref name="young">((cite journal |last1=Young |first1=Terry |last2=Peppard |first2=Paul E. |last3=Gottlieb |first3=Daniel J. |title=Epidemiology of Obstructive Sleep Apnea: A Population Health Perspective |journal=American Journal of Respiratory and Critical Care Medicine |date=May 2002 |volume=165 |issue=9 |pages=1217–1239 |doi=10.1164/rccm.2109080 |pmid=11991871 |s2cid=23784058 ))</ref> People who are overweight have more tissues in the back of their throat which can restrict the airway, especially when sleeping.<ref>((cite news |last1=Watson |first1=Stephanie |title=Weight loss, breathing devices still best for treating obstructive sleep apnea |url=https://www.health.harvard.edu/blog/weight-loss-breathing-devices-still-best-for-treating-obstructive-sleep-apnea-201310026713 |work=Harvard Health Blog |date=2 October 2013 ))</ref> In weight loss studies of overweight individuals, those who lose weight show reduced apnea frequencies and improved apnoea–hypopnoea index (AHI).<ref name="young"/><ref>((cite journal | vauthors = Tuomilehto HP, Seppä JM, Partinen MM, Peltonen M, Gylling H, Tuomilehto JO, Vanninen EJ, Kokkarinen J, Sahlman JK, Martikainen T, Soini EJ, Randell J, Tukiainen H, Uusitupa M | title = Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea | journal = American Journal of Respiratory and Critical Care Medicine | volume = 179 | issue = 4 | pages = 320–7 | date = February 2009 | pmid = 19011153 | doi = 10.1164/rccm.200805-669OC ))</ref> Weight loss effective enough to relieve obesity hypoventilation syndrome (OHS) must be 25–30% of body weight. For some obese people, it can be difficult to achieve and maintain this result without [[bariatric surgery]].<ref>((cite journal |last1=Mokhlesi |first1=Babak |last2=Masa |first2=Juan Fernando |last3=Brozek |first3=Jan L. |last4=Gurubhagavatula |first4=Indira |last5=Murphy |first5=Patrick B. |last6=Piper |first6=Amanda J. |last7=Tulaimat |first7=Aiman |last8=Afshar |first8=Majid |last9=Balachandran |first9=Jay S. |last10=Dweik |first10=Raed A. |last11=Grunstein |first11=Ronald R. |last12=Hart |first12=Nicholas |last13=Kaw |first13=Roop |last14=Lorenzi-Filho |first14=Geraldo |last15=Pamidi |first15=Sushmita |last16=Patel |first16=Bhakti K. |last17=Patil |first17=Susheel P. |last18=Pépin |first18=Jean Louis |last19=Soghier |first19=Israa |last20=Tamae Kakazu |first20=Maximiliano |last21=Teodorescu |first21=Mihaela |title=Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline |journal=American Journal of Respiratory and Critical Care Medicine |date=1 August 2019 |volume=200 |issue=3 |pages=e6–e24 |doi=10.1164/rccm.201905-1071ST |pmid=31368798 |pmc=6680300 ))</ref>

===Rapid palatal expansion===
((see also|Palatal expansion))

In children, orthodontic treatment to expand the volume of the nasal airway, such as nonsurgical rapid [[palatal expansion]] is common. The procedure has been found to significantly decrease the AHI and lead to long-term resolution of clinical symptoms.<ref>((cite journal |last1=Villa |first1=Maria Pia |last2=Rizzoli |first2=Alessandra |last3=Miano |first3=Silvia |last4=Malagola |first4=Caterina |title=Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up |journal=Sleep and Breathing |date=1 May 2011 |volume=15 |issue=2 |pages=179–184 |doi=10.1007/s11325-011-0505-1 |pmid=21437777 |s2cid=4505051 ))</ref><ref>((cite journal |last1=Machado-Júnior |first1=Almiro-José |last2=Zancanella |first2=Edilson |last3=Crespo |first3=Agrício-Nubiato |title=Rapid maxillary expansion and obstructive sleep apnea: A review and meta-analysis |journal=Medicina Oral, Patología Oral y Cirugía Bucal |date=2016 |volume=21 |issue=4 |pages=e465–e469 |doi=10.4317/medoral.21073 |pmid=27031063 |pmc=4920460 ))</ref>

Since the palatal suture is fused in adults, regular RPE using tooth-borne expanders cannot be performed. Mini-implant assisted rapid palatal expansion (MARPE) has been recently developed as a non-surgical option for the transverse expansion of the maxilla in adults. This method increases the volume of the nasal cavity and nasopharynx, leading to increased airflow and reduced respiratory arousals during sleep.<ref>((cite journal |last1=Li |first1=Qiming |last2=Tang |first2=Hongyi |last3=Liu |first3=Xueye |last4=Luo |first4=Qing |last5=Jiang |first5=Zhe |last6=Martin |first6=Domingo |last7=Guo |first7=Jing |title=Comparison of dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion |journal=The Angle Orthodontist |date=1 May 2020 |volume=90 |issue=3 |pages=432–441 |doi=10.2319/080919-522.1 |pmid=33378437 |pmc=8032299 |doi-access=free ))</ref><ref>((cite journal |last1=Abdullatif |first1=Jose |last2=Certal |first2=Victor |last3=Zaghi |first3=Soroush |last4=Song |first4=Sungjin A. |last5=Chang |first5=Edward T. |last6=Gillespie |first6=M. Boyd |last7=Camacho |first7=Macario |title=Maxillary expansion and maxillomandibular expansion for adult OSA: A systematic review and meta-analysis |journal=Journal of Cranio-Maxillofacial Surgery |date=1 May 2016 |volume=44 |issue=5 |pages=574–578 |doi=10.1016/j.jcms.2016.02.001 |pmid=26948172 ))</ref> Changes are permanent with minimal complications.

===Surgery===
[[File:Cautérisation des parties molles - apnée du sommeil.svg|thumb|Illustration of surgery on the mouth and throat]]

Several surgical procedures ([[sleep surgery]]) are used to treat sleep apnea, although they are normally a third line of treatment for those who reject or are not helped by CPAP treatment or dental appliances.<ref name=Spi2015/> Surgical treatment for obstructive sleep apnea needs to be individualized to address all anatomical areas of obstruction.((medical citation needed|data=February 2024|date=February 2024))

====Nasal obstruction====
Often, correction of the nasal passages needs to be performed in addition to correction of the [[oropharynx]] passage. [[Septoplasty]] and turbinate surgery may improve the nasal airway,<ref>((cite journal |last1=Sundaram |first1=Supriya |last2=Lim |first2=Jerome |last3=Lasserson |first3=Toby J |last4=Lasserson |first4=TJ |title=Surgery for obstructive sleep apnoea in adults |journal=Cochrane Database of Systematic Reviews |date=19 October 2005 |issue=4 |pages=CD001004 |doi=10.1002/14651858.CD001004.pub2 |pmid=16235277 ))</ref> but has been found to be ineffective at reducing respiratory arousals during sleep.<ref>((cite journal |last1=Li |first1=Hsueh-Yu |last2=Wang |first2=Pa-Chun |last3=Chen |first3=Yu-Pin |last4=Lee |first4=Li-Ang |last5=Fang |first5=Tuan-Jen |last6=Lin |first6=Hsin-Ching |title=Critical Appraisal and Meta-Analysis of Nasal Surgery for Obstructive Sleep Apnea |journal=American Journal of Rhinology & Allergy |date=January 2011 |volume=25 |issue=1 |pages=45–49 |doi=10.2500/ajra.2011.25.3558 |pmid=21711978 |s2cid=35117004 ))</ref>

====Pharyngeal obstruction====
[[Tonsillectomy]] and [[uvulopalatopharyngoplasty]] (UPPP or UP3) are available to address pharyngeal obstruction.((medical citation needed|data=February 2024|date=February 2024))

[[File:UPPP. 4 figures..png|thumb|upright=1.5|Uvulopalatopharyngoplasty. A) pre-operative, B) original UPPP, C) modified UPPP, and D) minimal UPPP.]]

The "Pillar" device is a treatment for snoring and obstructive sleep apnea; it is thin, narrow strips of polyester. Three strips are inserted into the roof of the mouth (the [[soft palate]]) using a modified syringe and local anesthetic, in order to stiffen the soft palate. This procedure addresses one of the most common causes of snoring and sleep apnea&nbsp;— vibration or collapse of the soft palate. It was approved by the FDA for snoring in 2002 and for obstructive sleep apnea in 2004. A 2013 meta-analysis found that "the Pillar implant has a moderate effect on snoring and mild-to-moderate obstructive sleep apnea" and that more studies with high level of evidence were needed to arrive at a definite conclusion; it also found that the polyester strips work their way out of the soft palate in about 10% of the people in whom they are implanted.<ref name=pillar>((cite journal | vauthors = Choi JH, Kim SN, Cho JH | title = Efficacy of the Pillar implant in the treatment of snoring and mild-to-moderate obstructive sleep apnea: a meta-analysis | journal = The Laryngoscope | volume = 123 | issue = 1 | pages = 269–76 | date = January 2013 | pmid = 22865236 | doi = 10.1002/lary.23470 | s2cid = 25875843 ))</ref>

====Hypopharyngeal or base of tongue obstruction====
Base-of-tongue advancement by means of advancing the genial tubercle of the mandible, tongue suspension, or [[hyoid suspension]] (aka hyoid myotomy and suspension or hyoid advancement) may help with the lower pharynx.((medical citation needed|data=February 2024|date=February 2024))

Other surgery options may attempt to shrink or stiffen excess tissue in the mouth or throat, procedures done at either a doctor's office or a hospital. Small shots or other treatments, sometimes in a series, are used for shrinkage, while the insertion of a small piece of stiff plastic is used in the case of surgery whose goal is to stiffen tissues.<ref name=SleepApneaTreatments/>

====Multi-level surgery====
[[Maxillomandibular advancement]] (MMA) is considered the most effective surgery for people with sleep apnea, because it increases the posterior airway space (PAS).<ref>((cite journal | vauthors = Prinsell JR | title = Maxillomandibular advancement surgery for obstructive sleep apnea syndrome | journal = Journal of the American Dental Association | volume = 133 | issue = 11 | pages = 1489–97; quiz 1539–40 | date = November 2002 | pmid = 12462692 | doi = 10.14219/jada.archive.2002.0079 ))</ref> However, health professionals are often unsure as to who should be referred for surgery and when to do so: some factors in referral may include failed use of CPAP or device use; anatomy which favors rather than impedes surgery; or significant craniofacial abnormalities which hinder device use.<ref name="auspre01">((cite journal |author=MacKay, Stuart |title=Treatments for snoring in adults |journal=Australian Prescriber |volume=34 |issue=34 |pages=77–79 |date=June 2011 |doi=10.18773/austprescr.2011.048 |doi-broken-date=31 January 2024 |doi-access= ))</ref>

====Potential complications====
Several inpatient and outpatient procedures use sedation. Many drugs and agents used during surgery to relieve pain and to depress consciousness remain in the body at low amounts for hours or even days afterwards. In an individual with either central, obstructive or mixed sleep apnea, these low doses may be enough to cause life-threatening irregularities in breathing or collapses in a patient's airways.<ref>((cite book |first1=T. Scott |last1=Johnson |first2=William A. |last2=Broughton |first3=Jerry |last3=Halberstadt |title=Sleep Apnea&nbsp;– The Phantom of the Night: Overcome Sleep Apnea Syndrome and Win Your Hidden Struggle to Breathe, Sleep, and Live |publisher=New Technology Publishing |year=2003 |isbn=978-1-882431-05-2 |url-access=registration |url=https://archive.org/details/sleepapneaphanto0000john ))((Page needed|date=September 2010))</ref> Use of analgesics and sedatives in these patients postoperatively should therefore be minimized or avoided.((medical citation needed|data=February 2024|date=February 2024))

Surgery on the mouth and throat, as well as dental surgery and procedures, can result in postoperative swelling of the lining of the mouth and other areas that affect the airway. Even when the surgical procedure is designed to improve the airway, such as tonsillectomy and adenoidectomy or tongue reduction, swelling may negate some of the effects in the immediate postoperative period. Once the swelling resolves and the palate becomes tightened by postoperative scarring, however, the full benefit of the surgery may be noticed.((medical citation needed|data=February 2024|date=February 2024))

A person with sleep apnea undergoing any medical treatment must make sure their doctor and [[Nurse anesthetist|anesthetist]] are informed about the sleep apnea. Alternative and emergency procedures may be necessary to maintain the airway of sleep apnea patients.<ref>((cite web |url=http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_LivingWith.html |title=What is Sleep Apnea? |year=2012 |website=National Heart, Lung, and Blood Institute |publisher=National Institutes of Health |access-date=15 February 2013 |url-status=live |archive-url=https://web.archive.org/web/20110828030048/http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_LivingWith.html |archive-date=28 August 2011))</ref>

===Other===

====Neurostimulation====
[[Diaphragm pacing]], which involves the rhythmic application of electrical impulses to the diaphragm, has been used to treat central sleep apnea.<ref name="BhimjiDia15">((EMedicine|article|1970348|Diaphragm Pacing))</ref><ref>((cite journal | vauthors = Yun AJ, Lee PY, Doux JD | title = Negative pressure ventilation via diaphragmatic pacing: a potential gateway for treating systemic dysfunctions | journal = Expert Review of Medical Devices | volume = 4 | issue = 3 | pages = 315–9 | date = May 2007 | pmid = 17488226 | doi = 10.1586/17434440.4.3.315 | s2cid = 30419488 ))</ref>

In April 2014, the U.S. Food and Drug Administration granted pre-market approval for use of an upper airway stimulation system in people who cannot use a continuous positive airway pressure device. The Inspire Upper Airway Stimulation system senses respiration and applies mild electrical stimulation during inspiration, which pushes the tongue slightly forward to open the airway.<ref name="FDAInspire14">((cite web |url=https://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/recently-approveddevices/ucm398321.htm |title=Inspire Upper Airway Stimulation&nbsp;– P130008 |work=FDA.gov |publisher=Food and Drug Administration |date=11 January 2016 |access-date=9 March 2016 |url-status=live |archive-url=https://web.archive.org/web/20160311075714/https://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/recently-approveddevices/ucm398321.htm |archive-date=11 March 2016 ))</ref>

====Medications====
There is currently insufficient evidence to recommend any medication for OSA.<ref name="Efficacy of pharmacotherapy for OSA">((cite journal |last1=Gaisl |first1=Thomas |last2=Haile |first2=Sarah R. |last3=Thiel |first3=Sira |last4=Osswald |first4=Martin |last5=Kohler |first5=Malcolm |title=Efficacy of pharmacotherapy for OSA in adults: A systematic review and network meta-analysis |journal=Sleep Medicine Reviews |date=August 2019 |volume=46 |pages=74–86 |doi=10.1016/j.smrv.2019.04.009 |pmid=31075665 |s2cid=149455430 ))</ref> This may result in part because people with sleep apnea have tended to be treated as a single group in clinical trials. Identifying specific physiological factors underlying sleep apnea makes it possible to test drugs specific to those causal factors: airway narrowing, impaired muscle activity, low arousal threshold for waking, and unstable breathing control.<ref name="Dolgin"/><ref name="Wellman">((cite journal |last1=Wellman |first1=Andrew |last2=Eckert |first2=Danny J. |last3=Jordan |first3=Amy S. |last4=Edwards |first4=Bradley A. |last5=Passaglia |first5=Chris L. |last6=Jackson |first6=Andrew C. |last7=Gautam |first7=Shiva |last8=Owens |first8=Robert L. |last9=Malhotra |first9=Atul |last10=White |first10=David P. |title=A method for measuring and modeling the physiological traits causing obstructive sleep apnea |journal=Journal of Applied Physiology |date=June 2011 |volume=110 |issue=6 |pages=1627–1637 |doi=10.1152/japplphysiol.00972.2010 |pmid=21436459 |pmc=3119134 ))</ref>
Those who experience low waking thresholds may benefit from [[eszopiclone]], a sedative typically used to treat insomnia.<ref name="Dolgin"/><ref>((cite journal |last1=Eckert |first1=Danny J. |last2=Owens |first2=Robert L. |last3=Kehlmann |first3=Geoffrey B. |last4=Wellman |first4=Andrew |last5=Rahangdale |first5=Shilpa |last6=Yim-Yeh |first6=Susie |last7=White |first7=David P. |last8=Malhotra |first8=Atul |title=Eszopiclone increases the respiratory arousal threshold and lowers the apnoea/hypopnoea index in obstructive sleep apnoea patients with a low arousal threshold |journal=Clinical Science |date=7 March 2011 |volume=120 |issue=12 |pages=505–514 |doi=10.1042/CS20100588 |pmid=21269278 |pmc=3415379 |url=https://doi.org/10.1042/CS20100588 |access-date=10 May 2022 |issn=0143-5221))</ref> The  antidepressant [[desipramine]] may stimulate upper airway muscles and lessen pharyngeal collapsibility in people who have limited muscle function in their airways.<ref name="Dolgin"/><ref>((cite journal |last1=Taranto-Montemurro |first1=Luigi |last2=Sands |first2=Scott A. |last3=Edwards |first3=Bradley A. |last4=Azarbarzin |first4=Ali |last5=Marques |first5=Melania |last6=Melo |first6=Camila de |last7=Eckert |first7=Danny J. |last8=White |first8=David P. |last9=Wellman |first9=Andrew |title=Desipramine improves upper airway collapsibility and reduces OSA severity in patients with minimal muscle compensation |journal=European Respiratory Journal |date=1 November 2016 |volume=48 |issue=5 |pages=1340–1350 |doi=10.1183/13993003.00823-2016 |pmid=27799387 |pmc=5437721 |url=https://erj.ersjournals.com/content/48/5/1340 |access-date=10 May 2022 |language=en |issn=0903-1936))</ref>

There is limited evidence for medication, but 2012 AASM guidelines suggested that [[acetazolamide]] "may be considered" for the treatment of central sleep apnea; [[zolpidem]] and [[triazolam]] may also be considered for the treatment of central sleep apnea,<ref name="Lambert">((cite journal |last1=Lambert |first1=Mara |title=Updated Guidelines from AASM for the Treatment of Central Sleep Apnea Syndromes |journal=American Family Physician |date=15 November 2012 |volume=86 |issue=10 |pages=968–971 |url=https://www.aafp.org/afp/2012/1115/p968.html |access-date=10 May 2022 |issn=0002-838X))</ref> but "only if the patient does not have underlying risk factors for respiratory depression".<ref name="Efficacy of pharmacotherapy for OSA"/><ref name=2012review>((cite journal | vauthors = Aurora RN, Chowdhuri S, Ramar K, Bista SR, Casey KR, Lamm CI, Kristo DA, Mallea JM, Rowley JA, Zak RS, Tracy SL | title = The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses | journal = Sleep | volume = 35 | issue = 1 | pages = 17–40 | date = January 2012 | pmid = 22215916 | pmc = 3242685 | doi = 10.5665/sleep.1580 ))</ref>
Low doses of oxygen are also used as a treatment for hypoxia but are discouraged due to side effects.<ref name=PsychToday>((cite web |url=http://www.psychologytoday.com/conditions/sleep-apnea |title=Sleep Apnea |work=Diagnosis Dictionary |publisher=[[Psychology Today]] |url-status=live |archive-url=https://archive.today/20130408080751/http://www.psychologytoday.com/conditions/sleep-apnea |archive-date=8 April 2013 ))</ref><ref name="pmid11181239">((cite journal |last1=Mayos |first1=M. |last2=Hernández Plaza |first2=L. |last3=Farré |first3=A. |last4=Mota |first4=S. |last5=Sanchis |first5=J. |title=Efecto de la oxigenoterapia nocturna en el paciente con síndrome de apnea-hipopnea del sueño y limitación crónica al flujo aéreo |trans-title=The effect of nocturnal oxygen therapy in patients with sleep apnea syndrome and chronic airflow limitation |language=es |journal=Archivos de Bronconeumología |date=January 2001 |volume=37 |issue=2 |pages=65–68 |doi=10.1016/s0300-2896(01)75016-8 |pmid=11181239 ))</ref><ref name="pmid2609134">((cite journal | vauthors = Breitenbücher A, Keller-Wossidlo H, Keller R | title = Transtracheale Sauerstofftherapie beim obstruktiven Schlafapnoe-Syndrom |trans-title=Transtracheal oxygen therapy in obstructive sleep apnea syndrome | language = de | journal = Schweizerische Medizinische Wochenschrift | volume = 119 | issue = 46 | pages = 1638–1641 | date = November 1989 | pmid = 2609134 |oclc=119157195 ))</ref>

====Oral appliances====
An oral appliance, often referred to as a [[mandibular advancement splint]], is a custom-made mouthpiece that shifts the lower jaw forward and opens the bite slightly, opening up the airway. These devices can be fabricated by a general dentist. Oral appliance therapy (OAT) is usually successful in patients with mild to moderate obstructive sleep apnea.<ref>((cite journal | vauthors = Machado MA, Juliano L, Taga M, de Carvalho LB, do Prado LB, do Prado GF | title = Titratable mandibular repositioner appliances for obstructive sleep apnea syndrome: are they an option? | journal = Sleep & Breathing = Schlaf & Atmung | volume = 11 | issue = 4 | pages = 225–31 | date = December 2007 | pmid = 17440760 | doi = 10.1007/s11325-007-0109-y | s2cid = 24535360 ))</ref><ref name="ReferenceA">((cite journal | vauthors = Chen H, Lowe AA | title = Updates in oral appliance therapy for snoring and obstructive sleep apnea | journal = Sleep & Breathing = Schlaf & Atmung | volume = 17 | issue = 2 | pages = 473–86 | date = May 2013 | pmid = 22562263 | doi = 10.1007/s11325-012-0712-4 | s2cid = 21267378 ))</ref> While CPAP is more effective for sleep apnea than oral appliances, oral appliances do improve sleepiness and quality of life and are often better tolerated than CPAP.<ref name="ReferenceA"/>

====Nasal EPAP====
[[Nasal EPAP]] is a bandage-like device placed over the nostrils that uses a person's own breathing to create positive airway pressure to prevent obstructed breathing.<ref name=Riaz2015rev>((cite journal | vauthors = Riaz M, Certal V, Nigam G, Abdullatif J, Zaghi S, Kushida CA, Camacho M | title = Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis | journal = Sleep Disorders | volume = 2015 | pages = 734798 | date = 2015 | pmid = 26798519 | pmc = 4699057 | doi = 10.1155/2015/734798 | doi-access = free ))</ref>

====Oral pressure therapy====
[[Oral pressure therapy]] uses a device that creates a vacuum in the mouth, pulling the soft palate tissue forward. It has been found useful in about 25 to 37% of people.<ref>((cite journal | vauthors = Nigam G, Pathak C, Riaz M | title = Effectiveness of oral pressure therapy in obstructive sleep apnea: a systematic analysis | journal = Sleep & Breathing = Schlaf & Atmung | volume = 20 | issue = 2 | pages = 663–71 | date = May 2016 | pmid = 26483265 | doi = 10.1007/s11325-015-1270-3 | s2cid = 29755875 ))</ref><ref>((cite journal | vauthors = Colrain IM, Black J, Siegel LC, Bogan RK, Becker PM, Farid-Moayer M, Goldberg R, Lankford DA, Goldberg AN, Malhotra A | title = A multicenter evaluation of oral pressure therapy for the treatment of obstructive sleep apnea | journal = Sleep Medicine | volume = 14 | issue = 9 | pages = 830–7 | date = September 2013 | pmid = 23871259 | pmc = 3932027 | doi = 10.1016/j.sleep.2013.05.009 | url = http://www.escholarship.org/uc/item/3cd5x9qk ))</ref>

==Prognosis==
Death could occur from untreated OSA due to lack of oxygen to the body.<ref name=AHRQ2011>((cite web|url=https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=731|title=Diagnosis and Treatment of Obstructive Sleep Apnea in Adults|publisher=AHRQ Effective Health Care Program|date=8 August 2011|url-status=dead|archive-url=https://web.archive.org/web/20161231230122/https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=731|archive-date=31 December 2016)). A [https://www.effectivehealthcare.ahrq.gov/ehc/products/117/1534/sleep-apnea-surveillance-130502.pdf 2012 surveillance update] ((webarchive|url=https://web.archive.org/web/20170125113854/http://www.effectivehealthcare.ahrq.gov/ehc/products/117/1534/sleep-apnea-surveillance-130502.pdf |date=25 January 2017 )) found no significant information to update.</ref>

There is increasing evidence that sleep apnea may lead to liver function impairment, particularly [[fatty liver]] diseases (see [[steatosis]]).<ref name="aloiaetal">((cite journal | vauthors = Aloia MS, Sweet LH, Jerskey BA, Zimmerman M, Arnedt JT, Millman RP | title = Treatment effects on brain activity during a working memory task in obstructive sleep apnea | journal = Journal of Sleep Research | volume = 18 | issue = 4 | pages = 404–10 | date = December 2009 | pmid = 19765205 | doi = 10.1111/j.1365-2869.2009.00755.x | hdl = 2027.42/73986 | s2cid = 15806274 |hdl-access=free ))</ref><ref name="apnea">((cite journal | vauthors = Ahmed MH, Byrne CD | title = Obstructive sleep apnea syndrome and fatty liver: association or causal link? | journal = World Journal of Gastroenterology | volume = 16 | issue = 34 | pages = 4243–52 | date = September 2010 | pmid = 20818807 | pmc = 2937104 | doi = 10.3748/wjg.v16.i34.4243 | doi-access = free ))</ref><ref name="apnea2">((cite journal | vauthors = Singh H, Pollock R, Uhanova J, Kryger M, Hawkins K, Minuk GY | title = Symptoms of obstructive sleep apnea in patients with nonalcoholic fatty liver disease | journal = Digestive Diseases and Sciences | volume = 50 | issue = 12 | pages = 2338–43 | date = December 2005 | pmid = 16416185 | doi = 10.1007/s10620-005-3058-y | s2cid = 21852391 ))</ref><ref name="apnea3">((cite journal | vauthors = Tanné F, Gagnadoux F, Chazouillères O, Fleury B, Wendum D, Lasnier E, Lebeau B, Poupon R, Serfaty L | title = Chronic liver injury during obstructive sleep apnea | journal = Hepatology | volume = 41 | issue = 6 | pages = 1290–6 | date = June 2005 | pmid = 15915459 | doi = 10.1002/hep.20725 | doi-access = free ))</ref>

It has been revealed that people with OSA show tissue loss in brain regions that help store memory, thus linking OSA with memory loss.<ref>((cite journal | vauthors = Kumar R, Birrer BV, Macey PM, Woo MA, Gupta RK, Yan-Go FL, Harper RM | title = Reduced mammillary body volume in patients with obstructive sleep apnea | journal = Neuroscience Letters | volume = 438 | issue = 3 | pages = 330–4 | date = June 2008 | pmid = 18486338 | doi = 10.1016/j.neulet.2008.04.071 | s2cid = 207126691 ))</ref> Using [[magnetic resonance imaging]] (MRI), the scientists discovered that people with sleep apnea have [[mammillary bodies]] that are about 20% smaller, particularly on the left side. One of the key investigators hypothesized that repeated drops in oxygen lead to the brain injury.<ref>((cite journal | vauthors = Kumar R, Birrer BV, Macey PM, Woo MA, Gupta RK, Yan-Go FL, Harper RM | title = Reduced mammillary body volume in patients with obstructive sleep apnea | journal = Neuroscience Letters | volume = 438 | issue = 3 | pages = 330–4 | date = June 2008 | pmid = 18486338 | doi = 10.1016/j.neulet.2008.04.071 | s2cid = 207126691 | url = http://newswise.com/articles/view/541519/ | url-access = subscription ))</ref>

The immediate effects of central sleep apnea on the body depend on how long the failure to breathe endures. At worst, central sleep apnea may cause sudden death. Short of death, drops in blood oxygen may trigger [[seizure]]s, even in the absence of [[epilepsy]]. In people ''with'' epilepsy, the hypoxia caused by apnea may trigger seizures that had previously been well controlled by medications.<ref name="Epilepsy and sleep apnea syndrome"/> In other words, a seizure disorder may become unstable in the presence of sleep apnea. In adults with [[coronary artery disease]], a severe drop in blood oxygen level can cause [[angina]], [[Heart arrhythmia|arrhythmia]]s, or heart attacks ([[myocardial infarction]]). Longstanding recurrent episodes of apnea, over months and years, may cause an increase in carbon dioxide levels that can change the pH of the blood enough to cause a [[respiratory acidosis]].((medical citation needed|data=February 2024|date=February 2024))

==Epidemiology==
((Globalize|section|date=August 2016))
The Wisconsin Sleep Cohort Study estimated in 1993 that roughly one in every 15 Americans was affected by at least moderate sleep apnea.<ref name="pmid8464434" /><ref name="pmid19690624" /> It also estimated that in middle-age as many as 9% of women and 24% of men were affected, undiagnosed and untreated.<ref name="young"/><ref name="pmid8464434">((cite journal |last1=Young |first1=Terry |last2=Palta |first2=Mari |last3=Dempsey |first3=Jerome |last4=Skatrud |first4=James |last5=Weber |first5=Steven |last6=Badr |first6=Safwan |title=The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults |journal=New England Journal of Medicine |date=29 April 1993 |volume=328 |issue=17 |pages=1230–1235 |doi=10.1056/NEJM199304293281704 |pmid=8464434 |s2cid=9183654 |doi-access=free ))</ref><ref name="pmid19690624">((cite journal | vauthors = Lee W, Nagubadi S, Kryger MH, Mokhlesi B | title = Epidemiology of Obstructive Sleep Apnea: a Population-based Perspective | journal = Expert Review of Respiratory Medicine | volume = 2 | issue = 3 | pages = 349–364 | date = June 2008 | pmid = 19690624 | pmc = 2727690 | doi = 10.1586/17476348.2.3.349 ))</ref>

The costs of untreated sleep apnea reach further than just health issues. It is estimated that in the U.S., the average untreated sleep apnea patient's annual health care costs $1,336 more than an individual without sleep apnea. This may cause $3.4 billion/year in additional medical costs. Whether medical cost savings occur with treatment of sleep apnea remains to be determined.<ref>((cite journal |last1=Kapur |first1=Vishesh |last2=Blough |first2=David K. |last3=Sandblom |first3=Robert E. |last4=Hert |first4=Richard |last5=de Maine |first5=James B. |last6=Sullivan |first6=Sean D. |last7=Psaty |first7=Bruce M. |title=The Medical Cost of Undiagnosed Sleep Apnea |journal=Sleep |date=September 1999 |volume=22 |issue=6 |pages=749–755 |doi=10.1093/sleep/22.6.749 |pmid=10505820 |doi-access=free ))</ref>

== Frequency and population ==
Sleep disorders including sleep apnea have become an important health issue in the United States. Twenty-two million Americans have been estimated to have sleep apnea, with 80% of moderate and severe OSA cases undiagnosed.<ref name="www.sleepapnea.org-2017">((cite web |date=13 January 2017 |title=Sleep Apnea Information for Clinicians - www.sleepapnea.org |url=https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/ |access-date=30 March 2022 |website=www.sleepapnea.org |language=en-US))</ref>

OSA can occur at any age, but it happens more frequently in men who are over 40 and overweight.<ref name="www.sleepapnea.org-2017" />

==History==
A type of CSA was described in the German [[myth]] of [[Ondine's curse]] where the person when asleep would forget to breathe.<ref name=Yen2013>((cite book|last1=Yentis|first1=Steven M.|last2=Hirsch|first2=Nicholas P.|last3=Ip|first3=James|title=Anaesthesia and Intensive Care A-Z: An Encyclopedia of Principles and Practice|date=2013|publisher=Elsevier Health Sciences|isbn=978-0-7020-5375-7|page=428|url=https://books.google.com/books?id=Te7TAAAAQBAJ&pg=PA428))</ref> The clinical picture of this condition has long been recognized as a character trait, without an understanding of the disease process. The term "[[Pickwickian syndrome]]" that is sometimes used for the syndrome was coined by the famous early 20th-century physician [[William Osler]], who must have been a reader of [[Charles Dickens]]. The description of Joe, "the fat boy" in Dickens's novel ''[[The Pickwick Papers]]'', is an accurate clinical picture of an adult with obstructive sleep apnea syndrome.<ref>((cite journal | vauthors = Kryger MH | title = Fat, sleep, and Charles Dickens: literary and medical contributions to the understanding of sleep apnea | journal = Clinics in Chest Medicine | volume = 6 | issue = 4 | pages = 555–62 | date = December 1985 | doi = 10.1016/S0272-5231(21)00394-4 | pmid = 3910333 ))</ref>

The early reports of obstructive sleep apnea in the medical literature described individuals who were very severely affected, often presenting with severe [[hypoxemia]], [[hypercapnia]] and [[congestive heart failure]].((medical citation needed|data=February 2024|date=February 2024))

===Treatment===
The management of obstructive sleep apnea was improved with the introduction of [[continuous positive airway pressure]] (CPAP), first described in 1981 by Colin Sullivan and associates in [[Sydney]], Australia.<ref>((cite journal | vauthors = Sullivan CE, Issa FG, Berthon-Jones M, Eves L | title = Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares | journal = Lancet | volume = 1 | issue = 8225 | pages = 862–5 | date = April 1981 | pmid = 6112294 | doi = 10.1016/S0140-6736(81)92140-1 | s2cid = 25219388 ))</ref> The first models were bulky and noisy, but the design was rapidly improved and by the late 1980s, CPAP was widely adopted. The availability of an effective treatment stimulated an aggressive search for affected individuals and led to the establishment of hundreds of specialized clinics dedicated to the diagnosis and treatment of [[sleep disorders]]. Though many types of sleep problems are recognized, the vast majority of patients attending these centers have sleep-disordered breathing. Sleep apnea awareness day is 18 April in recognition of Colin Sullivan.<ref>((cite web|last=Sichtermann|first=Lori|title=Industry Recognizes Sleep Apnea Awareness Day 2014|date=19 April 2014|url=http://www.sleepreviewmag.com/2014/04/sleep-apnea-awareness-day-2014/|publisher=Sleep Review|access-date=30 April 2014|url-status=live|archive-url=https://web.archive.org/web/20140430083056/http://www.sleepreviewmag.com/2014/04/sleep-apnea-awareness-day-2014/|archive-date=30 April 2014))</ref>

== See also ==
((Portal|Medicine))
((div col|colwidth=20em))
* [[Congenital central hypoventilation syndrome]]
* [[Modes of mechanical ventilation]]
* [[Periodic breathing]]
* [[Obesity hypoventilation syndrome]]
* [[Respiratory disturbance index]] (RDI)
* [[Upper airway resistance syndrome]]
((div col end))

== References ==
((Reflist))

((Medical resources
| DiseasesDB       =
| ICD11            = ((ICD11|7A40)), ((ICD11|7A41)),
| ICD10            = ((ICD10|G47.3)),((ICD10|P28.3))
| ICD9             = ((ICD9|327.23)), ((ICD9|780.57))
| ICDO             =
| OMIM             =
| MedlinePlus      = 000811
| MedlinePlus_mult = ((MedlinePlus2|003997))
| eMedicineSubj    = ped
| eMedicineTopic   = 2114
| MeshID           = D012891
))
((Sleep))
((Authority control))

((DEFAULTSORT:Sleep Apnea))
[[Category:Breathing abnormalities]]
[[Category:Medical conditions related to obesity]]
[[Category:Sleep disorders]]
[[Category:Sleep physiology]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia neurology articles ready to translate]]
[[Category:Otorhinolaryngology]]

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