Obstructive sleep apnea syndrome may be just an annoyance to an affected person's bed partner, or it can be a more serious and even dangerous condition for the person involved. One clue to the condition is daytime somnolence, although not all sleepy patients have the syndrome. If obstructive sleep apnea syndrome is confirmed by a polysomnogram, a trial of nasal continuous positive airway pressure (NCPAP) is warranted. If daytime somnolence is unaffected, then it is unlikely that the syndrome is the sole cause of the patient's sleepiness. Alternative diagnoses (eg, narcolepsy, atypical depression) should then be considered. Surgery, orthodontic devices, and pharmacotherapy are generally less effective than NCPAP and are usually reserved for patients who cannot tolerate NCPAP. Surgical techniques may be best suited for patients who have clearly defined craniofacial abnormalities and those who cannot tolerate NCPAP. Weight reduction to near ideal body weight and avoidance of benzodiazepines, opiates, and alcohol should be emphasized in all patients with suspected or confirmed sleep apnea.
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