Obstructive sleep apnea: How to diagnose it and what is the preferred treatment for it?

Diagnosis: Obstructive sleep apnea syndrome is often overlooked clinically, with 93% of women and 82% of patients experiencing this condition going undiagnosed. Therefore, obese individuals with a history of hypertension, daytime sleepiness, and nighttime snoring should be suspected of having obstructive sleep apnea syndrome. A preliminary diagnosis can be made based on medical history, physical examination, and observation of the patient for more than 15 minutes after falling asleep, but definitive diagnosis requires polysomnography (PSG).

Prognosis: Obstructive sleep apnea syndrome has a high incidence rate and can easily lead to accidents; severe cases can result in death. A series of pathological changes caused by hypoxia and the worsening of complications, such as heart failure, respiratory failure, and arrhythmias, are the main causes of death. Reports indicate a 5-year survival rate of 94% and a 10-year survival rate of 72%, closely related to the number of sleep apneas per night.

Treatment: 1. General Treatment: The first-line treatment for obstructive sleep apnea syndrome caused by obesity is weight loss. A 10% weight loss reduces fat deposits around the upper airway, increasing its diameter and facilitating opening. This effectively improves symptoms and reduces the frequency and duration of sleep apnea. Furthermore, the supine position should be avoided during sleep; body position and pillow height should be adjusted to maintain upper airway patency.

2. Drug Treatment: Medroxyprogesterone acetate can enhance the respiratory center's driving capacity, improve ventilation response, and alleviate alveolar hypoventilation.

Clomipramine can inhibit REM sleep, reducing severe hypoxia and apnea caused by this phase, strengthening diaphragmatic contraction, and improving respiratory muscle function.