Obstructive Sleep Apnoea



Obstructive sleep apnoea is caused by collapse of the pharyngeal airway during sleep. It is characterised by apnoea episodes during sleep where the person will stop breathing periodically for up to a few minutes. This is usually reported by the partner as the patient is unaware of these episodes.

Risk Factors

  • Middle age
  • Male
  • Obesity
  • Alcohol
  • Smoking

 

Features

  • Apnoea episodes during sleep (reported by partner)
  • Snoring
  • Morning headache
  • Waking up unrefreshed from sleep
  • Daytime sleepiness
  • Concentration problems
  • Reduced oxygen saturation during sleep

 

Severe cases can cause hypertension, heart failure and can increase the risk of myocardial infarction and stroke.

 

Epworth Sleepiness Scale

The Epworth Sleepiness Scale is used to assess symptoms of sleepiness associated with obstructive sleep apnoea.

TOM TIP: If interviewing someone that you suspect has obstructive sleep apnoea ask about their daytime sleepiness and their occupation. Daytime sleepiness is a key feature that should make you suspect obstructive sleep apnoea. Patients that need to be fully alert for work, for example heavy goods vehicle operators, require urgent referral and may need amended work duties whilst awaiting assessment and treatment.

 

Management

Referral to an ENT specialist or a specialist sleep clinic where they can perform sleep studies. This involves the patient sleeping in a laboratory whilst staff monitor their oxygen saturations, heart rate, respiratory rate and breathing to establish any apnoea episodes and the extent of their snoring.

The first step in management is to correct reversible risk factors by advising them to stop drinking alcohol, stop smoking and lose weight.

The next step is to use a continuous positive airway pressure (CPAP) machine that provides continuous pressure to maintain the patency of the airway.

Surgery is another option. This involves quite significant surgical restructuring of the soft palate and jaw. The most common procedure is called uvulopalatopharyngoplasty (UPPP).

 

Last updated March 2019
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