✓ Evidence Based

Obstructive Sleep Apnea: Symptoms, Causes, Treatment

Obstructive Sleep Apnea (OSA) stands as the most common sleep-related breathing disorder affecting millions worldwide (1). Globally, approximately 936 million adults suffer from varying degrees of obstructive sleep apnea (2) . Among the hallmark signs of OSA, snoring is prevalent in as many as 94% of individuals with the condition (3).

What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea (OSA) is a common sleep disorder in which individuals experience recurring interruptions in breathing throughout their sleep cycles (4).

Distinguished by the relaxation of throat muscles, OSA obstructs the airway intermittently during sleep, leading to recurrent episodes of irregular breathing (5). An indicative symptom of OSA is habitual snoring, often observed by partners or family members (6). Thankfully, various treatments exist to alleviate the symptoms of OSA and improve sleep quality.

Symptoms of Obstructive Sleep Apnea

Identifying signs of obstructive sleep apnea (OSA) is crucial for early diagnosis and treatment.

Common Symptoms

Here are the common indicators to watch out for:

  • Snoring (7)
  • Daytime sleepiness or fatigue (8)
  • Morning headaches (9)
  • Dry mouth or sore throat upon waking (10)
  • Night sweats (11.
  • Waking up suddenly and feeling like you’re gasping or choking (12)
  • Restlessness during sleep (13, 14)
  • Trouble concentrating, forgetfulness, depression, or crankiness (15, 16)
  • Low sex drive (17)
  • Trouble getting up in the mornings (18)
  • High blood pressure (19)
  • Waking up often in the middle of the night to urinate (20)
  • Gastroesophageal reflux disease (GERD) (21)

Symptoms in Children

It’s worth noting that in children, symptoms of OSA may present differently and include:

  • Choking or drooling during sleep (22)
  • Excessive sweating at night (23)
  • Bed-wetting (24)
  • Learning and behavioral difficulties (25)
  • Academic performance issues (26)
  • Observing the rib cage moving inward during exhalation (27)
  • Snoring (28)
  • Teeth grinding (29)
  • Excessive daytime sleepiness mistaken for laziness (30)
  • Breathing pauses or interruptions during sleep (31)
  • Unusual sleeping positions, such as sleeping on hands and knees or with the neck hyperextended (32)
  • Restlessness in bed (33)

These symptoms may overlap with other medical conditions. Consulting a healthcare provider is essential to accurately diagnose and address potential underlying issues. If you share a bed with someone, they may notice your symptoms before you do, highlighting the importance of seeking medical evaluation if sleep disturbances are observed.

Causes of Obstructive Sleep Apnea

Understanding the underlying causes of OSA is crucial for effective management and treatment. Conditions associated with OSA include:

  • Obesity Hypoventilation Syndrome: This condition occurs in individuals with obesity and involves impaired breathing during sleep (34)
  • Chronic Lung Disease: Respiratory conditions like asthma, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis may contribute to OSA by obstructing airways (35).
  • Endocrine Conditions: Hormonal imbalances, such as hypothyroidism, acromegaly, and polycystic ovary syndrome, may impact breathing patterns during sleep (36)
  • Heart or Kidney Failure: Conditions causing fluid retention, such as heart or kidney failure, may result in the accumulation of fluid in the neck, obstructing the upper airway and contributing to OSA (37).
  • Pregnancy: Pregnant individuals may experience temporary changes in breathing patterns due to hormonal fluctuations and increased pressure on the airway (38)
  • Neuromuscular Conditions: Neurological conditions like stroke may disrupt brain signals to chest muscles and airways, leading to breathing difficulties during sleep (39).

Recognizing and addressing the underlying conditions associated with OSA is essential for effective management and treatment of this sleep disorder.

Risk factors of Obstructive Sleep Apnea

Identifying the risk factors associated with OSA is crucial for early detection and effective management of this condition. Several factors may increase the risk of developing OSA:

  • Obesity: Excess body weight, especially around the neck, may lead to the narrowing of the upper airway, making it more susceptible to collapse during sleep (40).
  • Neck Size: Men with a collar size of 17 inches or more and women with a collar size of 16 inches or more are at a higher risk of OSA due to the increased likelihood of airway narrowing (41).
  • Large Tongue: An oversized tongue may fall back and block the airway, particularly when lying flat during sleep (42).
  • Enlarged Tonsils: Large tonsils may obstruct the airway, contributing to breathing difficulties during sleep (43).
  • Smoking: Tobacco smoke irritates and inflames the upper airway, contributing to airway narrowing and worsening of OSA symptoms (44).
  • Retrognathia: This condition occurs when the lower jaw is shorter than the upper jaw, leading to a reduced space in the throat and increased risk of airway obstruction (45).
  • Narrow Palate or Airway: Individuals with a narrow palate or airway are more prone to airway collapse during sleep, exacerbating OSA symptoms (46).
  • Family History: A family history of OSA may predispose individuals to the condition, suggesting a genetic component in its development (47).

It is important to note that the presence of one or more of these risk factors does not necessarily guarantee the development of OSA, but rather increases the likelihood. Understanding these risk factors may aid in early intervention and preventive measures to mitigate the impact of OSA on overall health and quality of life.

Diagnosis of Obstructive Sleep Apnea

Diagnosing OSA involves a thorough evaluation by a healthcare professional, typically initiated by recognizing symptoms indicative of the condition.

Symptom Evaluation and Physical Examination

Upon seeking medical attention for suspected OSA, individuals undergo a comprehensive evaluation by a healthcare provider. This evaluation encompasses an assessment of symptoms related to sleep disturbances, such as excessive daytime fatigue, loud snoring, and witnessed breathing pauses during sleep (48).

Additionally, a physical examination is conducted, focusing on the examination of the throat, mouth, and nose. Measurements of neck and waist circumference, as well as blood pressure assessment, may also be performed to ascertain potential risk factors associated with OSA (49, 50).

Referral to Sleep Specialist

Following the initial evaluation, individuals may be referred to a sleep specialist for further assessment and diagnosis. Sleep specialists possess expertise in identifying and managing sleep disorders, including OSA (48) . They play an important role in conducting specialized tests and formulating personalized treatment plans based on the severity of the condition.

Specialized Tests for OSA Diagnosis

Polysomnography (PSG)

Polysomnography is considered the gold standard test for diagnosing OSA (51). During PSG, individuals undergo an overnight sleep study at a hospital or sleep center. Multiple physiological parameters are monitored simultaneously, including:

  • Electrooculogram (EOG) to monitor eye movements.
  • Electroencephalogram (EEG) to measure brain wave activity.
  • Electrocardiogram (ECG) to record heart rate and rhythm.
  • Electromyography (EMG) to assess muscle activity.
  • Pulse oximetry to measure blood oxygen levels.

Electroencephalogram (EEG) and Electrooculogram (EOG)

EEG electrodes placed on the scalp monitor brain waves, while EOG electrodes track eye movements. These measurements help in determining different sleep stages, including non-REM and REM sleep, crucial for identifying abnormalities associated with OSA.

Through the utilization of techniques such as polysomnography and physiological monitoring, clinicians may accurately diagnose OSA and devise tailored treatment strategies to improve patient outcomes and enhance overall quality of life.

Treatment of Obstructive Sleep Apnea

Effective management of OSA is crucial to mitigate associated health risks and improve overall quality of life. Treatment options include:

  • Weight Management: Weight loss, even as modest as 10%, may significantly alleviate symptoms of OSA by reducing the amount of soft tissue surrounding the upper airway, thus decreasing the likelihood of airway obstruction during sleep. (52, 53)
  • Sleep Positioning: Sleeping on the side rather than the back may help alleviate mild OSA by preventing the tongue and soft tissues from collapsing into the airway, thereby promoting unobstructed breathing. (54, 55)
  • Lifestyle Modifications: Avoidance of alcohol consumption and sedative medications, such as sleeping pills, is recommended as they may exacerbate muscle relaxation in the throat, contributing to airway collapse during sleep. (56, 57)
  • Continuous Positive Airway Pressure Therapy: These machines are designed to provide a steady flow of air via a mask worn either over the nose or mouth. This consistent airflow helps to prevent the collapse of the airway by ensuring there is a constant positive pressure in the upper air passage while the individual is asleep (58).
  • Nasal Therapies: Nasal sprays may be beneficial for individuals with OSA associated with nasal congestion or sinus issues, as they may alleviate nasal obstruction and improve airflow during sleep (59).
  • Oral Appliances: Dental devices, including mandibular advancement devices, work by repositioning the jaw and tongue to prevent airway collapse, particularly in cases of mild to moderate OSA. Customized oral appliances are prescribed by trained dental professionals based on individual patient needs (60).
  • Surgical Interventions: Surgery may be considered for patients with anatomical abnormalities contributing to airway obstruction, refractory to conservative treatments (61)
  • Somnoplasty: Utilizing radiofrequency energy, this minimally invasive procedure aims to stiffen and tighten the soft palate, reducing tissue collapse and improving airflow (62).
  • Upper Airway Stimulator: A surgically implanted device, such as the Inspire system, stimulates the airway muscles to prevent collapse during sleep, offering a targeted approach for select patients (63).
  • Nasal Surgery: Procedures such as septoplasty address nasal obstructions, enhancing airflow and reducing OSA severity. (64)
  • Uvulopalatopharyngoplasty (UPPP): UPPP involves the removal of excess tissue from the throat and palate to widen the airway, often recommended for individuals with specific anatomical obstructions (65).
  • Maxillomandibular Advancement Surgery: Reserved for severe cases of OSA with underlying craniofacial abnormalities, this surgical intervention repositions the upper and lower jaw to enlarge the airway space, effectively reducing airway resistance during sleep (66).

Close collaboration between patients, sleep specialists, and healthcare providers is essential in implementing a comprehensive treatment plan for optimal outcomes in OSA management.

Coping with Obstructive Sleep Apnea

Although OSA cannot typically be cured, appropriate treatment measures may significantly reduce breathing disruptions during sleep, enhance sleep quality, and mitigate associated health risks. Below are some practical tips to help individuals navigate life with OSA.

  • Seek Support: Adjusting to the daily use of Positive Airway Pressure (PAP) therapy or other treatments may be challenging. Engaging with online platforms and support groups comprising individuals with OSA may offer valuable insights and emotional support, facilitating the adaptation process.
  • Keep Caution While Driving: OSA may lead to daytime drowsiness and diminished alertness, posing risks while driving or operating machinery. It’s imperative for individuals with OSA to recognize these potential hazards and take appropriate precautions.
  • Avoid Aggravating Substances: Individuals with OSA should steer clear of substances known to exacerbate breathing issues during sleep, such as sedatives, benzodiazepines, narcotics, and alcohol. Consulting with a healthcare provider before using these substances is advisable.
  • Regular Follow-ups with Healthcare Providers: Maintaining regular communication with a healthcare professional, preferably a sleep specialist, is crucial post-diagnosis. These professionals may offer guidance on PAP device usage, address any concerns or difficulties encountered, evaluate treatment efficacy, and monitor for potential side effects over time.
  • Inform Healthcare Providers About OSA: Individuals with OSA must communicate their diagnosis to all medical professionals involved in their care, particularly before undergoing anesthesia or receiving pain medications. This ensures appropriate precautions are taken to prevent airway obstructions during medical procedures.

Additionally, prioritizing sufficient nightly sleep is essential for individuals with OSA. Alongside adhering to prescribed treatment regimens, adopting healthy sleep hygiene practices may further enhance sleep quality and overall well-being.


Obstructive Sleep Apnea is a significant health concern that affects millions of people worldwide, impacting their quality of life and increasing the risk of serious complications such as cardiovascular disease and stroke. Recognizing the symptoms and seeking timely diagnosis and treatment are crucial steps in managing OSA effectively. By adopting lifestyle changes and adhering to prescribed therapies, individuals with OSA may experience improvements in sleep quality, daytime functioning, and overall well-being.