Gabriel Angel Tamburini

Via S. Luigi Versiglia, 36 – 62012 - Civitanova Marche (MC)
333/8315560

EOS-DRS EXPERT

Obstructive Sleep Apnea Syndrome (OSAS) is a highly prevalent condition in the general population and represents a serious and growing health, social, and economic issue. Epidemiological data show that OSAS is more common among individuals between 40 and 65 years of age, with a prevalence of 4% in males, 2% in females, and approximately 1% in preschool-aged children.

Obstructive Sleep Apnea Syndrome is the most common form of sleep-related breathing disorder. It is characterized by repeated episodes during sleep of either complete obstruction (apnea) or partial obstruction (hypopnea) of the upper airway, caused by anatomical and/or functional abnormalities of the airway structures. Under normal conditions during sleep, each breath is associated with a slight reduction in the diameter of the collapsible segment of the pharyngeal walls. This occurs as a result of myoelastic forces that counteract the negative intraluminal pressure generated by airflow passing along these airway walls.

An alteration of this biomechanical balance leads to the development of progressively more complex respiratory events, beginning with snoring and eventually progressing to apnea. These events are responsible for the onset of syndromes associated with multi-organ consequences and complications. For this reason, Obstructive Sleep Apnea Syndrome (OSAS) is considered a multidisciplinary disease that requires coordinated diagnostic and therapeutic management among different specialists in order to provide comprehensive and optimal care for patients of all ages. As previously mentioned, the collapse of the pharyngeal walls causes an interruption of breathing, resulting in hemoglobin desaturation and a subsequent state of central alertness with frequent micro-arousals. The cyclical repetition of these events leads to fragmented and non-restorative sleep, resulting in a range of symptoms including daytime sleepiness, an increased risk of road traffic accidents (3.5 to 8 times higher than in the general population), cognitive impairment, memory and concentration difficulties, sexual dysfunction, and morning headaches.

Numerous epidemiological studies have shown that sleep apnea syndrome is a significant risk factor for, and is associated with, many of the leading causes of death in Western countries, including systemic arterial hypertension, coronary artery disease, heart failure, atrial fibrillation, stroke, diabetes mellitus, renal failure, and chronic obstructive pulmonary disease (COPD).

The primary risk factor for OSAS is obesity, although several other factors may contribute, including:

Anatomical and functional abnormalities (craniofacial deformities, nasal and pharyngeal obstruction, velopharyngeal abnormalities, and alterations of the hyoid–tongue–mandibular complex);
Associated medical conditions (GERD, epilepsy, endocrine and metabolic disorders);
Smoking;
Alcohol consumption and certain medications (such as sedatives and benzodiazepines).

The diagnosis of OSAS requires not only a thorough clinical evaluation but also appropriate instrumental investigations to identify the site of obstruction and assess any associated complications.

How the Diagnostic Pathway Begins

The diagnostic and therapeutic pathway begins with a comprehensive medical history, including information provided by the patient's bed partner when available. This is followed by an assessment of daytime sleepiness using validated questionnaires, a complete ENT evaluation (including physical examination, flexible fiberoptic rhinolaryngoscopy, rhinomanometry, and sleep endoscopy), as well as imaging studies when indicated.
Polysomnography or overnight cardiorespiratory monitoring represents the diagnostic gold standard for sleep apnea syndrome. These examinations allow the number and type of respiratory events occurring during sleep to be quantified by measuring oronasal airflow, thoracoabdominal movements, respiratory sounds, oxygen saturation (SpO₂), and heart rate.

Treatment options for OSAS include:

Continuous Positive Airway Pressure (CPAP) therapy, which remains the gold standard treatment in quantitative terms, reducing the number of obstructive apneas to nearly zero, although patient compliance and tolerance may sometimes be limited;
Educational and behavioral therapy programs, including weight management and lifestyle modification;
Mandibular Advancement Devices (MADs);
ENT or maxillofacial surgery.

Snoring surgery has evolved considerably over the years, despite being a relatively young field, with numerous surgical techniques developed over time, including more recent robotic-assisted procedures. The choice of treatment should be the result of a comprehensive diagnostic evaluation performed by a multidisciplinary team capable of tailoring therapy to the individual patient while considering treatment acceptance and long-term adherence. For this reason, continuous professional training and collaboration among ENT specialists with expertise in sleep medicine are essential, together with the development of specialized referral centers dedicated to snoring and sleep apnea surgery.