Sleep apnea.

The diagnosis of sleep apnea should be considered when a patient complains of snoring and excessive daytime somnolence. Middle-aged obese men are at particular risk, although apnea can occur in women and the elderly, as well as in persons who are not obese. An overnight polysomnographic sleep study can reveal the degree and type of apnea. Effective medical therapy can provide prompt clinical improvement. General treatment measures include weight loss and, in mild cases, training the patient to sleep in a side-lying position. Continuous positive airway pressure administered by masks worn at night is especially effective. Surgical treatment can help properly selected patients. Uvulopalatopharyngoplasty, which increases the volume of the oropharynx, requires follow-up polysomnographic studies. Tracheostomy is extremely effective and can be lifesaving in severe obstructive apnea. Effective therapeutic options make early recognition and treatment of this disorder vital and successful.