What, then, should be the clinical approach to patients with OSA? Which patients should be offered UPPP as a therapeutic alternative? To come to grips with this question, the medical implications of OSA must be clearly understood and appreciated. Both patient and physician must appreciate that this is a serious medical problem. Whereas snoring alone is generally considered a social issue, albeit often a considerable one, OSA is associated with significant health implications. The cycle of frequent nighttime arousals that accompanies OSA is rarely reported by patients. However, because these frequent interruptions in sleep disrupt normal sleep patterns, patients with OSA are often sleep deprived. This constant sleep fragmentation results in hypersomnolence and interferes substantially with the performance of routine activities and cognitive tasks.5-8 Regulatory agencies now also recognize the danger of OSA-related hypersomnolence in the workplace and on highways. Guidelines are being developed to restrict the activities of severely affected individuals.9
Severe cardiovascular disease is also common in patients with OSA. Hypertension, cardiac arrhythmia, left ventricular dysfunction, myocardial infarction, pulmonary hypertension, stroke, and sudden death are all more common in patients with this condition.10 Systemic hypertension has been reported in up to 50% of patients with OSA, and one report implicated undiagnosed OSA in as many as 40% of patients with essential systemic hypertension.11 In an often quoted study by He et al.12 in 1988, a large cohort of patients with OSA were evaluated at the Henry Ford Hospital Sleep Disorders Center and followed for up to 9 years. Untreated subjects with an AHI of >20 had significantly increased mortality compared with those with less severe AHI scores. Aggressive treatment with nasal continuous positive airway pressure (CPAP) appeared to reverse this trend, clearly implicating OSA for the increased mortality.
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