Risk Factors And Etiology

Studies have indicated that sleep apnea is more common in men and increases with age. In addition, it is more frequent in African-Americans than in whites.8 Males over age 40 who are obese, smoke, or use alcohol are at increased risk for snoring and OSA.7 The strongest predictor for OSA is obesity. Studies show that the risk of OSA increases fourfold with an increase of the body mass index (BMI) by 1 standard deviation. Neck circumference is also a strong predictor, suggesting that upper body or central obesity is more predictive than generalized obesity.9

Hypothyroidism and menopause have also been associated with increased risk of OSA.10,11 There are a number of anatomical abnormalities and pathologies that can also lead to sleep apnea. Studies show that obese patients with OSA have an increase in the concavity of the posterior epiglottis. This change in shape is correlated with an increased BMI and with the severity of the airway collapse and OSA.12

Common symptoms of sleep apnea include fatigue, excessive daytime sleepiness, headache, and impaired thinking. Other symptoms are chronic snoring, depression, and personality changes.2 Children frequently present with attention deficit, decreased intelligence, hyperactivity, and aggressiveness. Children rarely present with daytime sleepiness because apnea in children causes less awakening.5 In addition, women tend to present more frequently than men with depression, insomnia, and hypothyroidism.13

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