Obstructive sleep apnea
ICD-10 G47.33
- ~0M
- US adults with moderate-severe OSA
- AHI ≥0
- diagnostic threshold for OSA
- ~0%
- remain undiagnosed
- 04
- Zepbound FDA approval for OSA + obesity
What is obstructive sleep apnea?
Obstructive sleep apnea (OSA) is repetitive upper airway collapse during sleep, causing oxygen desaturation, sleep fragmentation, and daytime fatigue. Strongly linked to obesity and to cardiovascular morbidity. Prevalence: ~14% of men, ~5% of women in middle age; rising with obesity rates.
What are the symptoms of obstructive sleep apnea?
- Loud snoring with witnessed pauses in breathing or choking/gasping awakenings
- Excessive daytime sleepiness (Epworth Sleepiness Scale ≥10)
- Morning headaches and dry mouth on waking
- Difficulty concentrating, memory problems, mood changes
- Nocturia (waking to urinate ≥2 times/night) — often overlooked OSA marker
- Refractory hypertension (especially morning blood pressure spikes)
Who is at risk for obstructive sleep apnea?
- BMI ≥30 (the largest modifiable risk factor)
- Male sex (2-3× higher prevalence; gap narrows after menopause)
- Age ≥40 (prevalence climbs through middle age)
- Large neck circumference (>17" men, >16" women)
- Family history of OSA
- Anatomic factors: enlarged tonsils, retrognathia, large tongue
- Alcohol or sedative use before sleep (relaxes upper airway muscles)
How is obstructive sleep apnea diagnosed?
STOP-BANG questionnaire for screening (snoring, tiredness, observed apnea, blood pressure, BMI, age, neck, gender). Confirmed by polysomnography or home sleep apnea test. Severity by Apnea-Hypopnea Index (AHI): mild 5-15, moderate 15-30, severe >30.
How is obstructive sleep apnea treated?
First-line: continuous positive airway pressure (CPAP). Weight loss for overweight patients reduces severity dramatically. Tirzepatide (Zepbound) FDA-approved 2024 for OSA in adults with obesity. Mandibular advancement devices for mild-moderate disease or CPAP-intolerant. Upper airway surgery for selected anatomic abnormalities. Hypoglossal nerve stimulation for moderate-severe OSA who cannot use CPAP.
Medications used for obstructive sleep apnea
Authority reference: aasm.org
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Related topics
Sources
Primary sources cited above. FDA labeling, peer-reviewed trials, and specialty-society guidelines only.
- Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity (SURMOUNT-OSA) · New England Journal of Medicine, 2024 · PMID 38869006
- Clinical Practice Guideline for Diagnostic Testing for Adult OSA · American Academy of Sleep Medicine, 2017 · PMID 28162150
People also ask
Can weight loss cure sleep apnea?
Significant weight loss reduces or eliminates OSA in many patients with obesity-driven disease. The SURMOUNT-OSA trial showed tirzepatide (Zepbound) reduced AHI by ~50% and reversed OSA in ~43% of trial participants at one year. Weight loss is now FDA-recognized as an OSA treatment, not just a risk-factor intervention.
What is the AHI and what numbers should I know?
AHI = Apnea-Hypopnea Index, the average breathing disturbances per hour during sleep. 5-15 = mild OSA, 15-30 = moderate, >30 = severe. AHI under 5 with symptoms can still be clinically significant (upper airway resistance syndrome). Goal of treatment is typically AHI <5 on therapy.
If I can't tolerate CPAP, what are my options?
Auto-titrating PAP often improves tolerance over fixed-pressure CPAP. Mandibular advancement devices (oral appliances fit by a dentist) work well for mild-moderate disease. Inspire (hypoglossal nerve stimulator, implanted) is FDA-approved for moderate-severe OSA who fail CPAP. Surgery (UPPP, jaw advancement, tonsillectomy) is anatomy-specific. Weight loss with a GLP-1 is now an evidence-backed primary option for obesity-driven OSA.
Why does OSA cause high blood pressure?
Repeated nighttime hypoxia + arousal triggers sympathetic activation, raising blood pressure that persists into the day. OSA is the most common cause of refractory hypertension (HTN not controlled on 3+ medications including a diuretic). Treating OSA often reduces blood pressure and medication burden.