Classification and Symptoms - Obstructive sleep apnea is classified as a sleep-related breathing disorder. - It is divided into two categories: adult OSA and paediatric OSA. - Obstructive sleep apnea is different from central sleep apnea. - The respiratory effort is assessed to classify the apnea as obstructive. - Obstructive sleep apnea-hypopnea syndrome is associated with daytime symptoms. - Common symptoms of OSA syndrome include daytime sleepiness, restless sleep, and loud snoring. - Less common symptoms include morning headaches, insomnia, and mood changes. - OSA can be transient and caused by upper respiratory infections or drug use. - Epstein-Barr virus can increase the size of lymphoid tissue and cause OSA. - OSA can be underdiagnosed in individuals who sleep alone. - Excessive daytime sleepiness is a hallmark symptom of OSA in adults. - OSA can cause changes in the neurons of the hippocampus and frontal cortex. - OSA is associated with problems in non-verbal information processing and memory. - Diagnosis of OSA is more common among people in relationships. - There is a stigma associated with loud snoring, particularly in females. - Hypersomnolence is not typical in young children with sleep apnea. - Children with severe OSA may appear over-tired or hyperactive. - OSA in children is often caused by obstructive tonsils and adenoids. - Excessive weight can also contribute to OSA in children. - The prevalence and characteristics of paediatric OSA have changed due to obesity.

Risk Factors - Obesity is a significant risk factor for OSA. - Fatty infiltration and fat deposits in the neck region can narrow the upper airway. - The severity of OSA is proportional to the degree of obesity. - Adenotonsillar hypertrophy is a common cause of OSA in children. - Changes in the prevalence and characteristics of paediatric OSA are linked to the obesity epidemic. - People with normal body mass indices (BMIs) can also have OSA, possibly due to increased muscle mass or decreased muscle tone. - Sleeping supine (on the back) and gravity can contribute to OSA development, confounded by neck obesity. - Use of CPAP can expand a collapsed upper airway, indicating airway collapse as the cause of OSA. - Throat lesions, especially enlarged tonsils, can aggravate OSA and their removal may provide relief. - Old age is often accompanied by muscular and neurological loss of upper airway muscle tone. - Decreased muscle tone can be caused by chemical depressants like alcohol and sedatives. - Permanent premature muscular tonal loss can be caused by traumatic brain injury, neuromuscular disorders, or poor adherence to treatments. - Age-related changes in muscle tone can increase the risk of OSA. - Post-menopausal women have a prevalence of OSA similar to men in the same age range. - Decreased muscle tone and increased soft tissue around the airway increase the risk of OSA. - Men, with increased mass in the torso and neck, are at higher risk of developing sleep apnea. - Women generally experience OSA less frequently and to a lesser degree due to physiology and possibly progesterone levels. - Post-menopausal women have a higher risk of developing OSA. - Medications and lifestyle factors can also contribute to OSA risk. - OSA has a genetic component. - Family history increases the likelihood of developing OSA. - Genetic factors play a role in OSA development. - Short lower jaws (neoteny) can cause OSA. - Narrow upper jaw contributes to OSA. - Small lower jaws can lead to crowded teeth and malocclusions. - Craniofacial syndromes can involve unusual facial features. - Down syndrome predisposes individuals to OSA. - OSA can occur as a post-operative complication. - Pharyngeal flap surgery is associated with post-operative OSA. - Flap obstruction can hinder respiration during sleep. - Healthcare professionals are becoming more aware of post-operative OSA. - Concerns of OSA have increased following pharyngeal flap surgery.

Pathophysiology - Transition from wakefulness to sleep is associated with reduced upper-airway muscle tone. - During REM sleep, muscle tone of the throat and neck relax, potentially obstructing airflow. - Neurological mechanisms can trigger sudden interruptions of sleep, causing gasping for air and awakening. - Sleep interruptions can lead to sleep deprivation and negative effects on growth, healing, and immune response. - Blocked upper airway, usually behind the tongue and epiglottis, is the fundamental cause of OSA. - Spontaneous upper-airway blockage causes are debated. - Pulmonologists and neurologists believe risk factors can be advanced age, brain injury, decreased muscle tone, long-term snoring, and increased soft tissue. - Otorhinolaryngologists believe risk factors can be structural features like enlarged tonsils, enlarged posterior tongue, fat deposits, impaired nasal breathing, floppy soft palate, or collapsible epiglottis. - Oral and maxillofacial surgeons believe risk factors can be primary forms of mandibular hypoplasia leading to glossoptosis. - Orthognathic surgery is believed to offer superior guarantees of OSA cure by some maxillofacial surgeons.

Consequences - OSA has physiological consequences such as hypoxia and sleep fragmentation. - Intermediate consequences include inflammation and metabolic dysfunction. - Clinical repercussions include pulmonary hypertension and heart diseases. - OSA can lead to accidents and obesity. - Increased risk of perioperative complications in patients with OSA. - OSA is the most common Sleep-Disordered Breathing in children. - Pre-term children are more likely to have OSA. - Untreated OSA in children can lead to long-term consequences. - OSA affects various domains of life, including organs and behavior. - Nocturnal symptoms of OSA are associated with daytime symptoms and neuroc