Sleep apnoea

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Obstructive Sleep Apnoea Syndrome (OSAS) is a common condition affecting all age groups.
In the middle aged population it affects 2-4% of men presenting a significant public health concern due to the associated cardinal daytime symptom of excessive sleepiness.

During sleep there is a loss of stability of the upper airwaywhich leads to pertial closure (hypopnoea) or complete obstruction (apnoea). This is associated with a drop in oxygen saturation and is terminated by a large inspiratory breath and arousal from sleep. The patient is often unaware of these events however their bed partners are often able to provide witnessed accounts of apnoea, chocking episodes and heroic snoring.

Although the breathing distrubance occurs during sleep the consequences of the fragmented sleep affects daytime functioning.

Excessive sleepiness impairs quality of life affecting relationships and cognitive function.
It also affects work performance and people with untreated apnoea are seven times more likely to have an RTA (NICE 2008), which may be due to a lapse in concentration, error of judgement or falling asleep at the wheel.

OSAS is also associated with hypertension which increases the risk of cardiovascular disease and stroke. (IMPRESS 2009) Although it is strongly connected with obesity, 30% of patients have a BMI <30.

Risk Factors
  • obesity
  • increasing age
  • male
  • alcohol
  • sedatives
  • certain craniofacial charateristics
    • retrognathia
    • enlarged tonsils
    • macroglossia
Daytime Symptoms
  • excessive sleepiness which can affect cognitive function, mood and quality of life
  • morning headaches
  • waken non refreshed
  • poor concentration / ability to make decisions
  • impaired work performance
  • difficlty driving - concentration lapse can be fatal
  • reduced libido
  • personality change- irritability, anxiety, aggression, depression
Night time Symptoms
  • snoring
  • apnoea
  • choking episodes
  • waken gasping
  • frequent wakenings
  • restless sleep
Other Causes
  • fragmented sleep
  • sleep deprivation
  • idiopathic hypersomnolence
  • shift work
  • depression
  • narcolepsy
  • hypothyroidism
  • RLS/PLM
  • medication
    • sedatives
    • caffine
    • theophyllines
    • amphetamines
    • beta blockers
    • SSRI
  • excess alcohol
  • neurological conditions
    • dystrophica myotonica
    • previous head injury
    • parkinsons
Patient Pathway

Medication and alternative causes of sleepiness
  • fragmented sleep
  • sleep deprivation
  • idiopathic hypersomnolence
  • shift work
  • depression
  • narcolepsy
  • hypothyroidism
  • RLS/PLM
  • medication
    • sedatives
    • caffine
    • theophyllines
    • amphetamines
    • beta blockers
    • SSRI
  • excess alcohol
  • neurological conditions
    • dystrophica myotonica
    • previous head injury
    • parkinsons

 

When to refer

If the following signs and syptoms present

  • Epworth Sleepiness Score >11
  • excessive daytime sleepiness which can affect cognitive function, mood and quality of life
  • waken non refreshed
  • snoring
  • apnoea
  • morning headaches

Refer via SCI Gateway

Advice for suspected OSAS

1. avoid sedatives
2. stop smoking
3. reduce alcohol intake and avoid alcohol 4 hours before bed
4. try to sleep on side
5. elevate bed head by 30 degrees
6. weight loss if BMI >25
7. encourage excercise
8. follow good sleep hygiene principles
9. if patient reports sleepiness while driving, advise they must stop until assessment complete

Further information

Classification of Obstructive Sleep Apnoea

Epworth Sleepiness Score

DVLA - sleep apnoea

British Thoracic Society position statement: Driving and obstructive sleep apnoea

Patient information can be accessed here

Glossary
Abbreviation Meaning
RLS Restless Leg Syndrome
PLM Periodic Limb Movements 
SSRI Selective serotonin reuptake inhibitors
BMI Body Mass Index
Editorial Information

Last reviewed: 31 May 2015

Next review: 31 May 2017

Author(s): Sleep / NIV Sister

Approved By: high-uhb.tam@nhs.net

Reviewer Name(s): Wendy Douglas