Obstructive sleep apnea (OSA) is the most common breathing problem that happens during sleep. This type of sleep apnea occurs when the upper airway becomes completely or partly blocked, causing breathing to stop or slow down during sleep. These events are called "apneas" when breathing stops completely or almost completely, or "hypopneas" when breathing is only slightly reduced. In both cases, oxygen levels in the blood may drop, sleep may be disrupted, or both may happen. If apneas or hypopneas happen often during sleep, they can harm the quality of sleep. This, along with lower oxygen levels, may lead to health problems and affect a person's quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to describe OSA when it causes daytime symptoms, such as extreme tiredness or trouble thinking clearly.

Most people with obstructive sleep apnea do not notice breathing problems while sleeping, even after waking up. A partner or family member may see signs like loud snoring, pauses in breathing, or gasping during sleep. People who live or sleep alone often do not know they have the condition. Symptoms can last for years or even decades without being recognized. Over time, a person may become used to feeling sleepy during the day, having headaches, or feeling very tired because of poor sleep. Obstructive sleep apnea has been linked to problems with thinking and memory, and there is a connection between snoring and certain brain-related disorders.

Classification

In the third edition of the International Classification of Sleep Disorders (ICSD-3), obstructive sleep apnea (OSA) is grouped with other sleep-related breathing disorders. It is separated into two types: adult OSA and pediatric OSA. Obstructive sleep apnea is different from central sleep apnea (CSA), which happens when breathing stops or slows because of reduced effort, not because of a blockage in the airway. To correctly identify OSA, it is important to check breathing effort during an apnea episode. In OSA, the diaphragm continues to work hard or even harder to breathe, even though airflow stops.

When hypopneas (partial breathing pauses) occur along with apneas, the condition is called obstructive sleep apnea-hypopnea. If this is linked to daytime sleepiness or other daytime symptoms, it is named obstructive sleep apnea-hypopnea syndrome. For a hypopnea to be classified as obstructive, it must include at least one of these signs: (1) snoring during the event, (2) reduced airflow through the nose and mouth, or (3) opposite movement of the chest and belly during breathing. If none of these signs are present, the hypopnea is classified as central hypopnea.

Signs and symptoms

Common signs of obstructive sleep apnea (OSA) include feeling very sleepy during the day without a clear reason, having trouble sleeping at night, waking up often, and snoring loudly (with periods of silence followed by gasps). Less common signs are headaches in the morning, difficulty falling asleep, trouble focusing, changes in mood like being easily upset or anxious, grinding teeth during sleep, forgetting things, a faster heartbeat or higher blood pressure, trouble having sex, gaining weight without a clear reason, needing to urinate more at night, frequent heartburn, and heavy sweating during sleep.

Some people may experience OSA only briefly, such as during an illness like a cold or tonsillitis, which can cause swollen throat tissues. Infections like mononucleosis, caused by the Epstein-Barr virus, can also temporarily lead to OSA by enlarging lymphoid tissue. OSA may also occur temporarily when someone uses drugs like alcohol, which can relax the body and disrupt normal sleep patterns.

A key sign of OSA in adults is extreme sleepiness during the day. People with long-term, severe OSA may fall asleep briefly during normal activities, such as during conversations. This can happen suddenly and may be noticeable to others.

Low oxygen levels during sleep caused by OSA can affect brain areas like the hippocampus and right frontal cortex. Studies using brain imaging have shown that OSA can lead to shrinkage in the hippocampus, which may impact thinking skills, memory, and the ability to solve problems. OSA may also increase the risk of developing Alzheimer’s disease.

Obesity is a major risk factor for OSA. In people with severe obesity, the risk of sleep apnea can be as high as 90%. However, 20% to 25% of people with sleep apnea are not overweight. It is important to identify these individuals because they are more likely to develop high blood pressure than overweight people without OSA. Non-overweight people with OSA may also be at higher risk for early heart disease. These risks increase as OSA becomes more severe. Other factors may include inherited physical traits, issues with breathing control, weak muscles in the throat, or a tendency to wake up easily during sleep.

Diagnosing OSA is more common in people who live with others, as partners often notice symptoms like loud snoring. People may feel embarrassed about snoring, and women are less likely to be told they snore or to admit it to doctors. Women may also be less likely to use CPAP machines fully, which help treat OSA.

While excessive sleepiness can occur in children, it is not typical for young children with OSA. Instead, children with severe OSA often seem overly tired or hyperactive and may have behavior issues like irritability or trouble paying attention.

Adults and children with severe OSA often have different physical traits. Adults are usually overweight with short, thick necks, while young children are often thin and may not grow well. This poor growth happens because breathing is so hard that the body burns calories quickly, and because nasal or throat blockages make eating uncomfortable. In children, OSA is often caused by enlarged tonsils or adenoids and may be cured by removing them.

In children, OSA can also be caused by being overweight, leading to symptoms like restlessness and tiredness. While enlarged tonsils and adenoids are the most common cause of OSA in children, obesity can also contribute to airway blockages during sleep. The rise in childhood obesity has increased the number of children with OSA, and the severity of OSA often depends on how overweight a child is.

Obesity narrows the airway due to fat deposits in the neck and throat. Extra weight also makes it harder to breathe and increases the risk of airway collapse during sleep. Daytime sleepiness from disrupted sleep can reduce physical activity, leading to weight gain. Because of this, some experts divide childhood OSA into two types: one linked to enlarged tonsils and adenoids without obesity, and another linked to obesity with less severe tonsil or adenoid enlargement. These types can lead to different health problems. Studies show that weight loss in overweight teens can reduce OSA symptoms.

Diagnosis

Obstructive sleep apnea (OSA) syndrome is diagnosed when a person experiences repeated times during sleep when the airway in the throat becomes partially or fully blocked. This causes pauses in breathing (apneas) or shallow breathing (hypopneas). The American Academy of Sleep Medicine (AASM) defines an apnea as a stop in airflow for at least 10 seconds, with airflow reduced by 90% or more. A hypopnea is defined as a reduction in airflow by 30% or more for at least 10 seconds, along with either a drop in blood oxygen levels or a sudden awakening from sleep.

To measure how serious the condition is, doctors use the Apnea-Hypopnea Index (AHI) or the Respiratory Disturbance Index (RDI). The AHI counts the average number of apneas and hypopneas per hour of sleep. The RDI includes these events plus times when a person wakes up due to breathing effort. OSA is diagnosed if the AHI is more than 5 events per hour and causes daytime sleepiness or fatigue, or if the RDI is 15 or more, regardless of symptoms. Daytime sleepiness is classified as mild, moderate, or severe based on how it affects daily life. A tool called the Epworth Sleepiness Scale (ESS) helps assess this by asking a person to rate how likely they are to fall asleep during the day.

Screening tools like the STOP, Berlin, and STOP-BANG questionnaires help identify possible OSA. These are short questionnaires that ask about symptoms and risk factors.

The most accurate way to diagnose OSA is through a Level 1 polysomnography (PSG) sleep study done in a lab. During this test, sensors monitor brain activity, breathing, oxygen levels, heart rate, and body movements.

An "event" is either an apnea (complete stop in airflow for 10 seconds or more) or a hypopnea (airflow reduced by 50% for 10 seconds or 30% if it causes a drop in oxygen or a sudden awakening). The AHI measures how many events occur per hour. For adults, an AHI below 5 is normal, 5–15 is mild, 15–30 is moderate, and 30 or more is severe. For children, an AHI below 1 is normal, 1–5 is mild, 5–10 is moderate, and 10 or more is severe.

OSA can also be diagnosed at home using a sleep test kit. These tests are more convenient and less expensive than lab tests, as they record sleep in the person’s usual environment. Home tests that use blood oxygen monitoring and a technology called Peripheral Arterial Tone (PAT) are approved for use at home. While these tests are not as accurate as lab tests, they are accepted by insurance companies in the United States for coverage purposes.

According to the International Classification of Sleep Disorders, OSA is diagnosed based on four criteria: 1) sleep problems like excessive sleepiness or fatigue, 2) breathing issues such as gasping or snoring during sleep, 3) interruptions in breathing, and 4) health conditions like high blood pressure or diabetes. A diagnosis is confirmed if there are five or more breathing events per hour of sleep (mild) or 15 or more (severe). If fewer than five events occur, OSA is not diagnosed.

Because sleep patterns can vary from night to night, doctors may need to perform multiple tests to confirm an OSA diagnosis.

Pathophysiology

The change from being awake to sleeping (either REM sleep or NREM sleep) is linked to less muscle tightness in the upper airway. During REM sleep, the muscles in the throat, neck, and most other body muscles become almost completely relaxed. This relaxation can cause the tongue and soft tissues in the throat and mouth to loosen, narrowing the airway and possibly blocking airflow into the lungs during breathing. This can reduce the amount of air the lungs receive. If the body senses very low oxygen levels in the blood or very hard breathing against a blocked airway, the brain may trigger a sudden wake-up, called a neurological arousal. This can cause a person to gasp for air and wake up briefly. These arousals rarely lead to full waking but can harm the quality of sleep. In severe cases of OSA, repeated interruptions in sleep can lead to sleep deprivation, which may affect normal growth, healing, and immune function, especially in children and young adults.

The main cause of OSA is a blocked upper airway, usually behind the tongue and epiglottis. In an awake person, the airway is open, but it may collapse when the person lies on their back and loses muscle tightness during deep sleep.

At the start of sleep, a person is in light sleep, and the throat muscles remain tight. Air moves smoothly and quietly. As the airway narrows, breathing becomes louder, and snoring begins due to increased air turbulence. Over time, snoring becomes louder as the air passage becomes narrower. Blood oxygen levels drop until breathing sounds stop, indicating a complete blockage of airflow, which may last several minutes.

Eventually, the person must briefly wake up from deep sleep into light sleep, which helps restore muscle tightness. This shift from deep to light to deep sleep can be recorded using ECT monitors. In light sleep, muscle tightness returns to normal, the airway opens, breathing becomes quiet, and blood oxygen levels rise. The person then returns to deep sleep, muscle tightness decreases again, and the cycle of noisy breathing and airway blockage repeats.

The number of apnea and hypopnea episodes per hour is counted to determine the severity of OSA. If a person has five or more episodes per hour, mild OSA may be diagnosed. If there are 30 or more episodes per hour, severe OSA may be diagnosed.

The causes of upper airway blockage during sleep are debated among medical professionals. Three main groups of medical opinions exist:

Some pulmonologists and neurologists suggest risk factors include:
– Older age, though OSA can occur in newborns, such as in Pierre Robin syndrome, and in people of all ages.
– Brain injury, though this explains only a small number of OSA cases.
– Reduced muscle tightness caused by drugs, alcohol, or neurological disorders, which also does not explain most OSA cases.
– Long-term snoring, which may cause nerve damage in the throat muscles.
– Extra soft tissue around the airway, often linked to obesity, though not all OSA patients are overweight.

Some otorhinolaryngologists believe structural issues, such as large tonsils, a large tongue, or fat deposits in the neck, may narrow the airway. Other factors include difficulty breathing through the nose, a floppy soft palate, or a weak epiglottis.

Some oral and maxillofacial surgeons believe the primary cause is a small jaw, which can lead to the tongue falling back and blocking the airway. Some surgeons who perform orthognathic surgery for OSA claim this treatment may offer effective long-term solutions.

Risk factors

It is well known that children, adolescents, or adults with OSA are often obese. People who are overweight or obese tend to have more fat in their necks, which can block their airways during sleep.

However, people of all ages and both genders with normal body mass indexes (BMIs) can also have OSA. These individuals may not have extra fat in their necks, as seen in scans. It is thought that they might have more muscle mass or weaker muscle tone, which can cause their airways to collapse during sleep.

Loss of muscle tone is a normal part of deep sleep. While obesity is often linked to OSA, it is not the only cause.

Sleeping on the back is a risk factor for OSA. Gravity and the loss of muscle tone in the tongue and throat during deep sleep can contribute to airway blockage. However, this explanation is complicated by the presence of neck fat.

CPAP machines help treat OSA by keeping the upper airway open, allowing for easier breathing through the nose. A positive response to CPAP confirms that airway collapse is the cause of OSA.

Throat issues, such as enlarged tonsils, are known to worsen OSA. Removing enlarged tonsils can provide full, partial, or long-term relief, showing that they may play a role in causing OSA.

Old age often leads to a loss of muscle tone in the upper airway. This can also happen temporarily due to substances like alcohol or sedatives. Permanent loss of muscle tone may result from brain injuries, neuromuscular disorders, or lack of proper treatment.

People with weak muscle tone, extra soft tissue around the airway, or structural features that narrow the airway are at higher risk for OSA. Men are more likely to develop OSA, especially in middle age and later, due to body structure. Women are less likely to have OSA, but this changes after menopause. Pregnancy also increases the risk for women.

Lifestyle factors like smoking can increase the chance of OSA. Smoke irritates the airway and causes swelling, which can narrow the airway. Smoking also affects sleep stability. Quitting smoking can reduce this risk. Children exposed to smoke may develop OSA due to swollen lymphoid tissue. Alcohol, sedatives, and other sleep-inducing drugs can worsen OSA because they relax muscles. Allergies and asthma are also linked to OSA through increased swelling in the airway.

OSA may be influenced by genetics. People with a family history of OSA are more likely to develop it. This could be due to inherited traits or conditions like obesity, jaw structure, or sleep-related issues.

Several genes linked to OSA have been identified, including DLEU1, DLEU7, CTSF, MSRB3, FTO, and TRIM66.

Recent research suggests that small lower jaws (neoteny) may contribute to OSA through a condition called glossoptosis. A smaller jaw can push the tongue backward, narrowing the airway. A narrow upper jaw also reduces airway space, which may explain why many OSA patients have trouble breathing through their nose, especially when lying down.

Maxillofacial surgeons treat conditions like small jaws, which can cause crowded teeth, misaligned bites, and OSA. Surgeries such as BIMAX, GenioPaully, and IMDO (in adolescents) can improve jaw size and reduce OSA symptoms. These treatments may replace traditional methods like CPAP, dental splints, or tonsillectomy.

Some genetic syndromes, like Down syndrome, increase the risk of OSA. Features such as weak muscle tone, a narrow throat, and a large tongue make OSA more likely. Obesity and enlarged tonsils further worsen OSA in people with Down syndrome. Over half of those with Down syndrome experience OSA, and some doctors recommend regular testing for this group.

In other syndromes, such as cleft palate, correcting the condition may lead to OSA. For example, closing a cleft palate can reduce airway space, causing breathing problems.

Surgical procedures that expand the airway, like mandibular advancement, are used in syndromes like Treacher Collins and Pierre Robin sequence. These may involve reducing tongue size, removing tonsils, or modifying the uvula and palate.

OSA can also occur after certain surgeries, such as pharyngeal flap surgery. This procedure may block airflow in the throat during sleep, causing breathing interruptions.

Consequences

There are three levels of consequences from obstructive sleep apnea (OSA): physiologic, intermediate, and clinical. Physiologic consequences include low oxygen levels, broken sleep, imbalances in body systems that control heart rate and breathing, or too much oxygen. Intermediate consequences involve inflammation, tightening of blood vessels in the lungs, problems with how the body uses energy, damage to proteins and fats, or increased body fat. Clinical consequences include high blood pressure in the lungs, accidents, obesity, diabetes, heart problems, and high blood pressure.

Obstructive sleep apnea is the most common type of sleep-disordered breathing (SDB) and affects up to 11% of children born on time. It is even more common in children born too early (3 to 6 times more often). As a type of SDB, OSA in children can cause many harmful effects, some lasting into adulthood. The effects of OSA in children are complex and affect many areas of health. If untreated, OSA can harm organs, body systems, behavior, mental health, and overall quality of life. Signs of OSA at night, such as snoring, gasping, restless sleep, or working hard to breathe, are linked to daytime issues like trouble focusing, learning problems, irritability, poor brain development, lower school performance, and behavioral challenges. For example, SDB like OSA can cause hyperactive behavior that may lead to a diagnosis of attention deficit hyperactivity disorder (ADHD). However, treating SDB can improve hyperactivity, and ADHD treatment may no longer be needed. Obesity can worsen OSA effects and change how symptoms appear. Studies show that, unlike adults, children with OSA can keep enough oxygen in their brains. However, OSA still harms the brain and may cause long-term problems with thinking and behavior. These issues are especially concerning because the brain is still developing. The more broken and uneven a child’s sleep is, the worse the effects tend to be. Improving sleep can reduce these effects. It is the disruption of sleep, not the total amount of sleep, that harms a child’s daytime abilities, such as causing hyperactivity.

Children with OSA may struggle with learning and remembering things, and OSA is linked to lower IQ scores in children. Untreated OSA may prevent children from reaching their full height.

Broken sleep at night is linked to problems with thinking and learning, so identifying SDB like OSA is important in children. These issues can improve with the right treatment for the sleep disorder. Common problems in children with OSA include hyperactivity, impulsiveness, aggressive behavior, poor social and communication skills, and reduced ability to adapt.

Children with OSA often have trouble with thinking, leading to difficulty paying attention, lower school performance, and lower IQ. Poor school performance is linked to OSA and may result from brain activity that disrupts sleep and low oxygen levels, which harm memory. A study of Indian children with OSA found lower grades in subjects like math, science, language, and physical education. This study showed how OSA affects learning and physical development. Problems with school performance may improve if surgery to remove the tonsils and adenoids is done to treat OSA. It is important to identify OSA in children with learning challenges, as many cases go unnoticed.

Studies show that learning and behavior can improve if OSA is treated, meaning some effects may be reversed. This reversal is more likely if OSA is treated early, as longer untreated OSA makes effects harder to fix.

Like adults, OSA in children increases the risk of heart problems due to overactive body systems and poor heart control. Heart issues linked to OSA include high blood pressure and unstable blood pressure (such as high or fluctuating levels). Blood pressure instability is linked to the severity of OSA symptoms, like how often breathing stops or slows. High blood pressure in the lungs is also common in children with OSA. Children with sleep-disordered breathing also have faster heart rates during the day and at night.

In adults, OSA is linked to insulin resistance. In children, OSA’s effects on metabolism are harder to study because they may also be linked to puberty and obesity. However, when OSA and obesity occur together, they can cause problems like insulin resistance, high cholesterol, liver disease, belly fat, and metabolic syndrome. Obesity worsens these effects.

Children with OSA also have a higher risk of bedwetting at night. This may happen because of too much urine at night, poor bladder function, or inability to wake up when the bladder is full. The risk of bedwetting increases with the severity of OSA: the more breathing problems per hour of sleep, the higher the risk. Obesity may also contribute, as it is linked to OSA and increased nighttime urine production. Treating OSA with surgery to remove the tonsils and adenoids can help reduce bedwetting. A study found that this surgery has a 60–75% chance of completely stopping bedwetting and an 80–85% chance of reducing its symptoms.

Untreated OSA in children can lead to shorter height. Growth hormone (HGH) is released during deep sleep, especially during non-REM stages. If sleep is disrupted, HGH may not be released properly, affecting growth. Children may grow slower than their peers.

Unlike adults, daytime sleepiness is not the most common symptom in children with OSA. However, using special tools, studies show that up to 40–50% of children with OSA experience daytime sleepiness, even if parents do not notice it. The risk of daytime sleepiness is higher when OSA is linked to obesity.

Because of these effects, identifying and treating OSA in children is crucial to prevent long-term health and development issues.

Management

Obstructive sleep apnea has several treatment options. Doctors recommend avoiding alcohol, smoking, and certain medications that relax the nervous system, such as sedatives and muscle relaxants. Weight loss is advised for those who are overweight. Continuous positive airway pressure (CPAP) and mandibular advancement devices are often used and work equally well. Physical training, even without weight loss, can improve sleep apnea. There is not enough evidence to support the use of most medications for this condition. In some cases, such as when tonsils are enlarged, a tonsillectomy may be recommended. For patients who do not respond to CPAP or oral devices, surgery like uvulopalatopharyngoplasty (UPPP) may be used. UPPP helps improve breathing during sleep and reduces daytime sleepiness.

The most common treatment is positive airway pressure, which uses a machine to deliver air through a mask over the nose or mouth. This air pressure keeps the airway open. Variants include:

• CPAP: Effective for moderate to severe sleep apnea and is the most common treatment.
• Variable positive airway pressure (VPAP): Provides higher pressure during inhalation and lower pressure during exhalation. It is more expensive and used for patients with other breathing issues or who find CPAP uncomfortable.
• Nasal EPAP: A band-like device over the nose that uses breathing to create pressure and prevent airway blockage.
• Auto CPAP: Adjusts pressure automatically based on the person’s breathing.
• A 5% weight loss in people with moderate to severe OSA may reduce symptoms as much as CPAP.

Using CPAP can be difficult for some people because it requires changing sleep habits. About 8% of users stop using CPAP after the first night, and 50% stop within a year. Educational programs and support can help improve long-term use.

Sleeping with the upper body elevated at a 30-degree angle or higher may help prevent airway collapse. Sleeping on the side instead of the back is also recommended.

Some studies suggest that playing wind instruments, like the didgeridoo, may reduce snoring and apnea. This may be more effective for double-reed instruments.

There is not enough evidence to support using medications like fluoxetine, paroxetine, acetazolamide, or tryptophan to treat OSA directly.

Recent research is studying cannabinoids, such as dronabinol (a synthetic form of THC), as a treatment for OSA. While some studies show reduced apnea symptoms, results are inconsistent. Long-term effects, including impacts on sleepiness and weight gain, are unclear. Due to uncertainty, medical cannabis is not recommended for OSA.

Drugs like solriamfetol, modafinil, and armodafinil are approved to manage daytime sleepiness caused by OSA, but not the condition itself.

For adults with obesity and moderate-to-severe OSA, a drug called tirzepatide (Zepbound) was approved in 2024 by the FDA after studies showed it reduced apnea events, weight, and blood pressure through significant weight loss. Medicare and many insurers began covering it for OSA in 2025.

Mandibular advancement splints are mouthguards that move the lower jaw forward, keeping the tongue from blocking the airway. They are used for mild to moderate OSA and snoring, especially in people with a low AHI, low BMI, and good teeth. They are non-invasive, easy to use, and generally well-tolerated but may not be as effective as CPAP.

Oral devices have been shown to improve sleep quality, reduce daytime sleepiness, and lower blood pressure. Improvements in device design focus on reducing bulk, allowing jaw movement, and enabling mouth breathing.

Tongue repositioning devices use soft acrylic to hold the tongue forward, increasing airway space. Hybrid devices combine jaw advancement with tongue restraint. These are used for snoring and OSA but are less popular due to discomfort during adjustment.

Soft-palate lifters are tools that raise the soft palate, helping people with weak muscles in that area.

There is not enough evidence to support oral appliances for children, but they may be used in specific cases, such as for children with craniofacial issues that increase apnea risk.

In children, orthodontic treatments like rapid palatal expansion are common to widen the nasal airway. In adults, a newer method called mini-implant-assisted rapid palatal expansion (MARPE) is used to expand the nasal cavity without surgery, improving airflow and reducing sleep disruptions.

Sleep surgery includes various procedures to treat OSA.

Prognosis

Sleep apnea is linked to serious health problems, including stroke and other heart and blood vessel diseases. People under 70 years old who have sleep apnea are more likely to die early. Those with sleep apnea have a 30% greater chance of having a heart attack or dying compared to people without the condition. In severe and long-lasting cases, high pressure in the lungs can harm the right side of the heart, leading to a serious type of heart failure called cor pulmonale. The heart’s ability to relax and fill with blood (diastolic function) is also harmed. High blood pressure can result from sleep apnea. When sleep apnea causes high blood pressure, it is different from most cases because blood pressure does not decrease much during sleep (non-dipper) or may even rise (inverted dipper).

Without treatment, the lack of sleep and oxygen caused by sleep apnea increases the risk of health issues such as heart disease, aortic problems (like aortic aneurysms), high blood pressure, stroke, diabetes, depression, weight gain, obesity, and even death.

Sleep apnea is connected to problems with thinking and memory, such as trouble with reasoning, attention, learning, and remembering information. It increases the risk of mild thinking problems and dementia. Sleep apnea has also been linked to changes in brain structure, including smaller sizes in parts of the brain like the hippocampus and the frontal and parietal lobes. These changes may improve at least partly with treatment using a CPAP machine.

Epidemiology

Until the 1990s, scientists had limited information about how often obstructive sleep apnea (OSA) occurs. A recent review of 24 studies on OSA in people aged 18 and older showed that when someone has 5 or more apnea events per hour, OSA was present in 9% to 38% of people. Specifically, 13% to 33% of men and 6% to 19% of women had this condition. Among people aged 65 and older, OSA was more common, affecting up to 84% of people, including 90% of men and 78% of women. However, when someone has 15 or more apnea events per hour, OSA was present in 6% to 17% of people overall, and nearly 49% of those aged 65 and older. Additionally, higher body mass index (BMI) is linked to a greater risk of OSA. For example, a 10% increase in body weight raises the risk of OSA by six times in both men and women.

OSA is often not diagnosed because it does not always cause daytime sleepiness, which can make the condition hard to notice. Studies estimate that OSA with daytime sleepiness affects 3% to 7% of men and 2% to 5% of women. This condition occurs in both developed and developing countries. OSA becomes more common with age and is most often diagnosed in people over 65 years old, with rates ranging from 22.1% to 83.6%. The number of people with OSA has grown in recent decades, partly due to the increasing rates of obesity.

Men are more likely to have OSA than women, but symptoms differ between the genders. Men are more likely to snore or have apnea events witnessed by others, while women are more likely to experience insomnia. OSA becomes more common in women as they age, especially after menopause and related hormonal changes. Women with OSA also face a higher risk of death compared to men.

If tested in a sleep lab using a formal sleep study called polysomnography, about 1 in 5 American adults is believed to have at least mild OSA. In the United States, some studies show that OSA is more common among Hispanic and African American populations than among white populations.

Society and culture

In the United States, private insurance companies are increasingly choosing home sleep testing as an option. For people with high out-of-pocket costs, a home sleep test may cost much less than a polysomnography test.

Radiofrequency ablation was approved by the American Academy of Otolaryngology as a treatment for mild to moderate obstructive sleep apnea in certain cases. However, the evidence supporting its use was not enough to recommend it as a standard treatment by the American College of Physicians.

Research

Neurostimulation is being studied as a possible treatment. A device that stimulates the hypoglossal nerve was approved in Europe in March 2012. Researchers are also studying exercises that strengthen the muscles around the mouth and throat, such as playing the didgeridoo.