This duo provide an eloquent outline of sleep disordered breathing in general, with particular emphasis on the medical impact and associations of the condition. The increasing prevalence of the condition is described, with increasing worldwide obesity, increased association of cardiac and metabolic comorbidities and rising use of opioid analgesics for chronic pain as the main culprits. It also serves as an excellent reminder of the reasons behind treatment, with studies showing increased likelihood of car accidents, mortality, excessive healthcare utilisation, and multiple areas of comorbidity. Specifically, the frequency of apnoeas and associated hypoxaemia can predict new cardiovascular disease, in particular with regard to recurrent atrial fibrillation and sudden cardiac death. In addition, the UK has demonstrated that treatment of OSA in diabetics significantly improves diabetic control, health status, and costs when compared to those who remain untreated. They then go on to concisely describe the four main medical therapies: positive pressure therapy; weight loss; pacing (phrenic / hypoglossal nerves); and oral devices. They remind us of the poor compliance of CPAP (50%) and that in some cases nocturnal oxygen therapy may be appropriate. If the apnoeas appear to be position related then restricting sleep positions may also be helpful. A useful medical overview of the topic, which is always beneficial from a surgeon’s perspective.

Current medical concepts in obstructive sleep apnea.
Pusalavidyasagar S, Iber C.
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Suzanne Jervis

FRCS (ORL HNS), Shrewsbury and Telford Hospitals, NHS Trust, UK.

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