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How to assess, diagnose, refer and treat adult obstructive sleep apnoea: a commentary on the choices

Obstructive sleep apnoea (OSA) is a condition characterised by repetitive occlusions of the upper airway during sleep, resulting in arousals and sleep fragmentation. It impacts on daytime vigilance1and contributes to cognitive dysfunction2and mood disorders.3 It is a source of lost productivity in the workplace4 and increases motor vehicle accident risk.5 OSA has also been implicated as a cause of hypertension,6 with studies showing small but consistent falls in blood pressure following continuous positive airway pressure (CPAP) treatment.7 Epidemiological studies have also shown OSA to be independently associated with an increased risk of diabetes8 and cardiovascular disease,9,10 although definitive evidence for a causal link with these diseases awaits the results of large-scale randomised controlled trials of OSA treatment. In the early 1990s, the prevalence of OSA in the community in the United States, determined by…