OBSTRUCTIVE SLEEP APNEA: PART I. DIAGNOSIS AND EVALUATION.

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Obstructive sleep apnea (OSA) is a common disorder that is characterized by repetitive partial or complete cessation of airflow, associated with oxyhemoglobin desaturation and increased effort to breath. Patients with undiagnosed sleep apnea represent a major public health problem. Dental professionals have a unique doctor patient relationship that can help them in recognizing the sleep disorder and co-managing the patients along with a physician or a sleep-specialist. This article discusses the etiology and pathogenesis, clinical features and risk factors, consequences, diagnosis and evaluation of Obstructive sleep apnea.
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[Bobby Joseph Babu, Mahesh CM, Rameshkumar PC, Vinay P Reddy, Chandrashekar BS and Harish Koushik. (2017); OBSTRUCTIVE SLEEP APNEA: PART I. DIAGNOSIS AND EVALUATION. Int. J. of Adv. Res. 5 (May). 1435-1443] (ISSN 2320-5407). www.journalijar.com
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