Editing Sleep apnea (section)

====Obstructive sleep apnea====
{{Main|Obstructive sleep apnea}}
[[File:ObstructiveApnea.png|thumb|Screenshot of a PSG system showing an obstructive apnea]]
[[File:New_no_obstruction.png|thumb|No airway obstruction during sleep]]
[[File:Airway_obstruction.png|thumb|Airway obstruction during sleep]]
In a systematic review of published evidence, the [[United States Preventive Services Task Force]] in 2017 concluded that there was uncertainty about the accuracy or clinical utility of all potential screening tools for OSA,<ref>{{cite journal |display-authors=6 |vauthors=Jonas DE, Amick HR, Feltner C, Weber RP, Arvanitis M, Stine A, Lux L, Harris RP |date=January 2017 |title=Screening for Obstructive Sleep Apnea in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force |journal=JAMA |volume=317 |issue=4 |pages=415–433 |doi=10.1001/jama.2016.19635 |pmid=28118460 |doi-access=free}}</ref> and recommended that evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults.<ref>{{cite journal |display-authors=6 |vauthors=Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW, García FA, Herzstein J, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Phillips WR, Phipps MG, Pignone MP, Silverstein M, Tseng CW |date=January 2017 |title=Screening for Obstructive Sleep Apnea in Adults: US Preventive Services Task Force Recommendation Statement |journal=JAMA |volume=317 |issue=4 |pages=407–414 |doi=10.1001/jama.2016.20325 |pmid=28118461 |doi-access=free}}</ref>

The diagnosis of OSA syndrome is made when the patient shows recurrent episodes of partial or complete collapse of the upper airway during sleep resulting in apneas or [[Hypopnea|hypopneas]], respectively.<ref name="Obstructive sleep apnea is a common">{{cite journal |vauthors=Franklin KA, Lindberg E |date=August 2015 |title=Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea |journal=Journal of Thoracic Disease |volume=7 |issue=8 |pages=1311–1322 |doi=10.3978/j.issn.2072-1439.2015.06.11 |pmc=4561280 |pmid=26380759}}</ref> Criteria defining an apnea or a hypopnea vary. The [[American Academy of Sleep Medicine|American Academy of Sleep Medicine (AASM)]] defines an apnea as a reduction in airflow of ≥ 90% lasting at least 10 seconds. A hypopnea is defined as a reduction in airflow of ≥ 30% lasting at least 10 seconds and associated with a ≥ 4% decrease in pulse [[Oxygenation (medical)|oxygenation]], or as a ≥ 30% reduction in airflow lasting at least 10 seconds and associated either with a ≥ 3% decrease in pulse oxygenation or with an arousal.<ref>Berry RB, Quan SF, Abrue AR, et al.; for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Version 2.6. Darien, IL: American Academy of Sleep Medicine; 2020.</ref>

To define the severity of the condition, the [[Apnea–hypopnea index|Apnea-Hypopnea Index]] (AHI) or the [[Respiratory disturbance index|Respiratory Disturbance Index]] (RDI) are used. While the AHI measures the mean number of apneas and hypopneas per hour of sleep, the RDI adds to this measure the respiratory effort-related arousals (RERAs).<ref>{{cite journal |vauthors=Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG |date=March 2017 |title=Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline |journal=Journal of Clinical Sleep Medicine |volume=13 |issue=3 |pages=479–504 |doi=10.5664/jcsm.6506 |pmc=5337595 |pmid=28162150}}</ref> The OSA syndrome is thus diagnosed if the AHI is > 5 episodes per hour and results in daytime sleepiness and fatigue or when the RDI is ≥ 15 independently of the symptoms.<ref>{{cite journal |last1=Thurnheer |first1=R. |date=September 2007 |title=Diagnosis of the obstructive sleep apnea syndrome |url=https://www.minervamedica.it/en/journals/minerva-pneumologica/article.php?cod=R16Y2007N03A0191 |journal=Minerva Pneumologica |volume=46 |issue=3 |pages=191–204 |s2cid=52540419 |access-date=21 March 2024 |archive-date=23 October 2020 |archive-url=https://web.archive.org/web/20201023215006/https://www.minervamedica.it/en/journals/minerva-pneumologica/article.php?cod=R16Y2007N03A0191 |url-status=live }}</ref> According to the American Association of Sleep Medicine, daytime sleepiness is determined as mild, moderate and severe depending on its impact on social life. Daytime sleepiness can be assessed with the [[Epworth Sleepiness Scale]] (ESS), a self-reported questionnaire on the propensity to fall asleep or doze off during daytime.<ref>{{cite journal |vauthors=Crook S, Sievi NA, Bloch KE, Stradling JR, Frei A, Puhan MA, Kohler M |date=April 2019 |title=Minimum important difference of the Epworth Sleepiness Scale in obstructive sleep apnoea: estimation from three randomised controlled trials |journal=Thorax |volume=74 |issue=4 |pages=390–396 |doi=10.1136/thoraxjnl-2018-211959 |pmid=30100576 |s2cid=51967356 |doi-access=free}}</ref> Screening tools for OSA comprise the STOP questionnaire, the Berlin questionnaire and the STOP-BANG questionnaire which has been reported as being a powerful tool to detect OSA.<ref>{{cite journal |display-authors=6 |vauthors=Chiu HY, Chen PY, Chuang LP, Chen NH, Tu YK, Hsieh YJ, Wang YC, Guilleminault C |date=December 2017 |title=Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: A bivariate meta-analysis |journal=Sleep Medicine Reviews |volume=36 |pages=57–70 |doi=10.1016/j.smrv.2016.10.004 |pmid=27919588}}</ref><ref>{{cite journal |vauthors=Amra B, Javani M, Soltaninejad F, Penzel T, Fietze I, Schoebel C, Farajzadegan Z |date=2018 |title=Comparison of Berlin Questionnaire, STOP-Bang, and Epworth Sleepiness Scale for Diagnosing Obstructive Sleep Apnea in Persian Patients |journal=International Journal of Preventive Medicine |volume=9 |issue=28 |page=28 |doi=10.4103/ijpvm.IJPVM_131_17 |pmc=5869953 |pmid=29619152 |doi-access=free}}</ref>