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Obstructive Sleep Apnoea

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Overview

Also known as hypopnea syndrome, obstructive sleep apnoea (OSA) is a sleep-related breathing disorder characterised by recurring episodes of partial/complete obstruction of the upper airway during sleep leading to apnoea (complete airflow obstruction and temporary absence of breathing). This leads to irregular breathing at night and excessive drowsiness during the day.

Epidemiology

  • OSA is more common in men
  • Prevalence is higher with age and obesity

Risk Factors

  • Obesity – strongest risk factor
  • Increasing age
  • Male sex
  • Family history
  • Smoking
  • Alcohol
  • Macroglossia (enlarged tongue) and adenoid tonsil hypertrophy
  • Down’s syndrome
  • Type 2 diabetes
  • Jaw morphology

Presentation

Patients often have unexplained daytime sleepiness. If possible, anyone that sleeps alongside the partner should be present when taking a history. Features are:

  • Excessive daytime sleepiness and feeling unrefreshed after sleep
  • Snoring
  • Their partner may notice periods of apnoea
  • Choking during sleep
  • Headaches on waking
  • Insomnia
  • Problems with memory or cognition
  • Hypertension can occur as a result

Investigations

All patients

  • Epworth Sleepiness Scale:
    • Assesses the severity of daytime sleepiness
  • Polysomnography (sleep studies) – diagnostic test:
    • This may involve measuring pulse oximetry at night or measuring multiple factors, such as an EEG, ECG, EMG, airflow assessments etc. 

Diagnosis

Diagnosis is based on polysomnography.

Management

All patients

  • 1st-line: weight loss + continuous positive airway pressure (CPAP) if moderate-severe OSA
  • Other options are: intra-oral mandibular advancement devices and upper airways surgery (e.g. tonsillectomy or uvulopalatopharyngoplasty) 

Patient Advice

  • Patients must notify the DVLA if their OSA causes excessive sleepiness
  • Patients should try to lose weight (if necessary) and be offered help with this
  • Patients should try to avoid sleeping supine where possible

Complications

  • Motor vehicle accidents due to excessive daytime sleepiness
  • Increased risk of cardiovascular disease
  • Depression
  • Hypertension
  • Stroke
  • Increased risk of type 2 diabetes

Prognosis

  • Treatment significantly decreases the risk of cardiovascular complications
  • CPAP therapy can reduce the blood pressure in hypertension secondary to OSA
  • For patients that respond to CPAP, the prognosis is excellent

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