Obstructive sleep apnea syndrome (OSAS) is a disorder in which complete or partial obstruction of the airway during sleep causes loud snoring, oxyhemoglobin desaturation and frequent arousals. As a result, affected persons have unrestful sleep and excessive daytime sleepiness. Because many patients are not aware of their heavy snoring and nocturnal arousals, obstructive sleep apnea may remain undiagnosed; therefore, it is helpful to question the bedroom partner of a patient with chronic sleepiness and fatigue. Because OSAS often occurs in obese persons with comorbid conditions, its individual contribution to health problems is difficult to discern. The disorder has, however, been linked to angina, nocturnal cardiac arrhythmias, myocardial infarction, stroke and motor vehicle accidents. Because the disorder is associated with significant morbidity and even some mortality, family physicians need to be familiar with its clinical presentation and treatment. OSAS is more common than was previously thought. Reported prevalence rates vary widely, and asymptomatic OSAS is more common than symptomatic, clinically significant OSAS. Population-based studies suggest that 2 percent of women and 4 percent of men over the age of 50 have symptomatic OSAS. The patient with OSAS is often brought to the physician’s office by a family member or bedroom partner who is being disturbed by the patient’s loud snoring. Usually, the patient stops breathing and then gives a loud gasp or snort when aroused by the apnea. These episodes are further complicated after the patient drinks alcohol or takes sleeping pills, because the sedatives decrease pharyngeal muscle tone and can exacerbate OSAS. Common signs in patients with OSAS include disrupted sleep, loud snoring, witnessed apnea, nocturnal gasping or choking, daytime sleepiness, fatigue and crowded posterior airway.

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