To different causes different treatments, OSA can have multifactoral origin as anatomic deficiencies (descendant soft palate, width tongue base, tick tonsils, enlarged adenoids in children), obesity producing accumulation if fat around the pharynx, personal habits such as smiking, drin

Such smoking, drinking liqour 2-3 hours before sleep time, use of muscle relaxants or dorsal position during sleep leading to mandibular retrusion. Each person must be considered individually for its diagnosis (by polysomnigraphy) and treatment (CPAP, mandibular advancement device, surgery, habit changes)

The goal in this situation is not only to diminish the apnea/hypopnea index but to avoid systemic comorbidities as carduovascular disease, diabetes or neurocognitive impairment

Although OSA is often found in obese patients, it is not exclusive to them.

I would like to see increased use of screening tools in family practice and pediatrics.

If we can screen, identify, diagnose and treat earlier, then we might decrease the complications related to untreated OSA.

I am a pediatric sleep specialist so OSA is a very important disease in my clinical practice. I have sickle cell patients that I treat most of the times and propose to T and A, obese patients , each time more frequent, so I have some on CPAP after T and A and also children with Down Syndrome that in some cases I also treat with CPAP. Another particular interesting group is ADHD children that should be investigated and treated if they have OSA because they improve their school performance.

In my hospital we usually perform, a Type I PSG, when we have a clinical suspicion of OSA and then propose medical or surgical therapy considerer light , moderate or severe OSA. In fact , I think that treating OSA during childhood is a major public health issue since it could decrease complications during adulthood.

I agree. I think that incorporating a screening tool for family practice and pediatrics practices would be helpful in early detection and treatment.

My most recent experience with OSA is in morbidly obese (200-300Kg) patients who are recovering from respiratory failure, with ventilator dependency.

It seems that we must interrupt the cycle of increasing obesity, pulmonary and systemic hypertension, obstruction, hypercapnea, weight gain, insulin resistance, carbohydrate craving, CHF and fluid retention. These seem to perpetuate one another until failure occurs. If we screen and treat appropriately and early, perhaps we could decrease the number of morbidly obese and those who develop obesity-related respiratory failure.

Sleep posture is critical. In my current Study covering multiple afflictions (not yet submitted, yet the headache and OSAdisplayed with poster presentation with Nour Al Timimi at Society for Neurosciences in 2012/) OSA is confirmed in a 258 unselected VA disability applicants to be present, by history, in 168 (65%). It was confirmed with testing in 96 ( 37%). All of those with OSA slept in a side-to-prone twisted sleep posture (the dominant sleep posture in >75% of 352 adults carefully evaluated with sleep postures confirmed).

In the 78% with twisted upper body sleep posture OSA was 75%. In the 17% who slept in a non-twisted (non-torqued) face-neutral posture, none were found with no history or evidence for OSA. Among the 17%, 10% did have other sleep dysfunctions — psych (PTSD) and or pain. The sleep posture association is a p value of 2.2x 01 to the -17.

BMIs are done on all subjects. They were not particularly highly correlated.

Obesity may be a problem, certainly not a game-changer — and highly difficult to change. Very few of the study subjects would even qualify as morbidly obese. Sleep posture, however, is quite determinable and quite changeable.

That is fascinating! Sleep posture could easily be incorporated into a screening tool, too.

For sure, the best way of managing OSA in clinical practice is to do it multidisciplinary: focus in treating the causes, plus nutrition, multimodal global and selective exercise and miofunctional training. Social cognitive interventions improve adherence of CPAP/BPAP treatments, and early detection improves outcomes as in many other diseases.

I work in the geriatric setting, where sleep problems prevalence is over 24% in Chile. Although OSA is considered a geriatric syndrome, we don´t see big interest in sleep during clinical practice, unless there is a properly diagnosed disease, so the challenge is to treat sleep disorders as the major public health issue they are.

Great question and comments.

Has anyone had difficulty getting some individuals to agree to a sleep study because they do not see (it's not intuitive) how possible OSA might contribute to their cardiovascular or metabolic or mental status problems? Anyone have a patient who associated heavy snoring with soundness of sleep. I find most patients open to at least temporary use of wearable tech to measure sleep quality. If an individual believes he/she has a problem, I've seen some quickly adopt to sleeping on their left side. Use of blue-blocking glasses and aps are probably not recommended enough. Hacks such as looking out at the dawn horizon (for earlier melatonin reset) are virtually unheard of.

@ Fazleh Mahomed - curious: have you ever considered setting up an account with a system where you could monitor the data from patients with wearable health devices opting to share that data with you? I suspect patient-driven systems are probably out their trying to recruit physician participation.

We should have a high degree of suspicion to diagnose OSA early

We often see patients who are obese and have all the criteria of OSA and were diagnosed with COPD, are often on home oxygen but have never been assessed for OSA.

Diagnosing these patients early by having a high degree of suspicion and having a sleep study followed by CPAP/BiPAP can prevent complications of associated hypertension, diabetes, ischemic heart disease, cor-pulonale, arrhythmias, and death.

Diagnosing OSA late when you can not reverse the associated complications is akin to doing "too little, too late"

For obesity and most chronic diseases " A pound of prevention is better than tons of treatment"

Awareness and self-knowledge and care regarding obesity in the modern times is the key to avoid its complications (Hypertension, diabetes, high cholesterol, osteoarthritis, gastrointestinal reflux, constipation, obstructive sleep apnea, and all complications related to it.

Affluence, easy availability of food, and modern electronic equipments (Television, computers, internet, smart phones) have made the work smart, but the people obese.

Over the centuries people have been digging their graves through their teeth. However, the speed of doing so has increased in modern age of "Couch potatoes".