Obstruksi Sleep Apnea Syndrome

Definition
Obstructive sleep apnea (OSA)also referred to as
obstructive sleep apnea-hypopneais a sleep disorder that
involves cessation or significant decrease in airflow in the
presence of breathing effort. It is the most common type of
sleep-disordered breathing and is characterized by
recurrent episodes of upper airway collapse during
sleep.[1] These episodes are associated with recurrent
oxyhemoglobin desaturations and arousals from sleep.

OSA that is associated with excessive daytime sleepiness is

commonly called obstructive sleep apnea syndromealso
referred to as obstructive sleep apnea-hypopnea syndrome.
 The image below illustrates the sleep-related
disordered breathing continuum ranging from simple
snoring to OSA.

Sleep-related disordered breathing continuum ranging from simple snoring to obstructive sleep apnea (OSA). Upper
airway resistance syndrome (UARS) occupies an intermediate position between these extremes. Note areas of
overlap among the conditions.
 Epidemiology
OSAS prevalence is variable depending on sex and
age; male 4%, female 2%, children 2%. Childhood
from 0 to 10. Adult from 40 t0 60 (women are more
likely to develop OSAS after menopause).
The prevalence of OSA is similar in both Caucasians
and Asians, this indicates that OSA is not only
common in developed but also in developing
countries.
However, the disease prevalence is higher in the
subgroups with overweight or obese subjects, elderly
people and those of different ethnic origin.
 Etiologies/Risk Factors
The etiology of OSA involves both structural and nonstructural factors, including
genetic factors.

A. Structural factors
Structural factors related to craniofacial bony anatomy that predispose patients with
OSA to pharyngeal collapse during sleep include the following:

Innate anatomic variations (facial elongation, posterior facial compression)

Retrognathia and micrognathia
Mandibular hypoplasia
Brachycephalic head form - Associated with an increased AHI in whites but not in
African Americans. [27]
Inferior displacement of the hyoid
Adenotonsillar hypertrophy, particularly in children and young adults
Pierre Robin syndrome
Down syndrome
Marfan syndrome
Prader-Willi syndrome
High, arched palate (particularly in women)
 Structural factors related to nasal obstruction
that predispose patients with OSA to pharyngeal
collapse during sleep include polyps, septal
deviation, tumors, trauma, and stenosis.

Structural factors related to retropalatal

obstruction include (1) an elongated, posteriorly
placed palate and uvula and (2) tonsil and
adenoid hypertrophy (particularly in children).
Structural factors related to retroglossal
obstruction include macroglossia and tumor.
B. Nonstructural risk factors
Nonstructural risk factors for OSA include the following:
Obesity
Central fat distribution
Male sex
Age
Postmenopausal state
Alcohol use
Sedative use
Smoking
Habitual snoring with daytime somnolence
Supine sleep position
Rapid eye movement (REM) sleep
 Familial factors also play a role (see below).[30] Families with a
high incidence of OSA are reported. Relatives of patients with
SDB have a 2- to 4-fold increased risk of SDB compared with
control subjects.

Other conditions associated with the development of OSA are as

follows:
Hypothyroidism
Neurologic syndromes
Stroke
Acromegaly
Environmental exposures