Sleep Medicine and Airway
Core concepts
Understand obstructive sleep apnoea as recurrent upper airway collapse during sleep, diagnosed by polysomnography (apnoea-hypopnoea index; mild 5–15, moderate 15–30, severe >30). Know the risk factors: obesity, male sex, large neck circumference, retrognathia, adenotonsillar hypertrophy (children), and craniofacial anomalies. Recognise consequences: daytime somnolence, hypertension, cardiovascular risk, and in children - failure to thrive, enuresis, behavioural problems. Know management: weight loss, CPAP (first-line for moderate/severe), mandibular advancement, and surgery (adenotonsillectomy first-line in children; uvulopalatopharyngoplasty, maxillomandibular advancement in selected adults). Understand drug-induced sleep endoscopy for surgical planning.
Traps
Do not diagnose OSA on history alone - confirm with sleep study. In children, adenotonsillectomy is first-line, not CPAP. Beware attributing all daytime sleepiness to OSA without excluding other causes. Distinguish central from obstructive events.
Rule of thumb
In a child with snoring, apnoeas, and behavioural or growth issues, think OSA and examine adenotonsillar size; adenotonsillectomy is first-line. In adults, confirm severity with polysomnography before choosing CPAP versus surgery.