Sleep-Wake Disorders
Obstructive Sleep Apnea Hypopnea
ICD-10-CM: G47.33
1. Criteria
DSM Criteria
Criterion A
- Either there is evidence by polysomnography of at least 5 obstructive apneas or hypopneas per hour of sleep and associated symptoms, or polysomnography shows 15 or more obstructive apneas or hypopneas per hour even without symptoms.
- Associated symptoms may include nocturnal breathing disturbances, snoring, snorting, gasping, breathing pauses during sleep, daytime sleepiness, fatigue, or nonrestorative sleep.
2. Context
- Obstructive sleep apnea hypopnea is a breathing-related sleep disorder in which airflow repeatedly narrows or stops during sleep, often leading to snoring, witnessed apneas, fragmented sleep, and daytime sleepiness. Many patients do not present saying they sleep badly. They present tired, foggy, hypertensive, or told by a partner that they stop breathing.
- History clues: Snoring, witnessed apneas, gasping, morning headaches, and excessive daytime sleepiness are often the first clues.
- Testing: Diagnosis typically depends on sleep testing rather than interview alone.
- Treatment frame: Primary treatment is not psychiatric. Airway-based treatment and sleep medicine management come first, with medication playing a narrower role.
- Clinical focus: Common screening tool for obstructive sleep apnea risk.
3. Validated scales
STOP-Bang
Common screening tool for obstructive sleep apnea risk.
Epworth Sleepiness Scale
Useful for tracking daytime sleepiness burden.
Polysomnography metrics
AHI and oxygen desaturation burden are central to confirmation and severity framing.
4. FDA approved treatments
FDA-approved medications for residual excessive sleepiness associated with OSA
Medication is not a replacement for airway treatment. These agents are used more narrowly for persistent excessive sleepiness in selected patients.
Common off-label medications
Interventional psychiatry modalities
- This is primarily a sleep medicine and airway disorder rather than an interventional psychiatry target.
- Positive airway pressure, oral appliances, and procedural airway approaches are the main treatment lanes.
- ECT, TMS, and ketamine are not treatments for OSA itself.
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