Obstructive Sleep Apnoea

• Obstructive sleep apnoea is caused by collapse of the pharyngeal airway
• Apnoeas are episodes where the person stops breathing for up to a few minutes. Partners may report the episodes, while patients are often unaware of them
• Risk factors for obstructive sleep apnoea


  • Middle age
  • Male
  • Obesity
  • Alcohol
  • Smoking
• Presenting features of obstructive sleep apnoea

  • Episodes of apnoea during sleep (reported by a partner)
  • Snoring
  • Morning headache
  • Waking up unrefreshed from sleep
  • Daytime sleepiness
  • Concentration problems
  • Reduced oxygen saturation during sleep
  • Severe cases can cause hypertension and heart failure and increase the risk of myocardial infarction and stroke
• When suspecting obstructive sleep apnoea during a history

  Ask about daytime sleepiness and occupation. Daytime sleepiness should make you suspect obstructive sleep apnoea. Patients that need to be fully alert for work, such as heavy goods vehicle operators, require an urgent referral and may need amended work duties while awaiting assessment and treatment
• The Epworth Sleepiness Scale
• Daytime sleepiness should make you suspect obstructive sleep apnoea
• Patients that need to be fully alert for work, such as heavy goods vehicle operators, require an urgent referral and may need amended work duties while awaiting assessment and treatment
• Epworth Sleepiness Scale


  • Used to assess symptoms of sleepiness associated with obstructive sleep apnoea
• Sleep Studies


  Used to confirm the diagnosis, performed by an ENT or sleep specialist service
• Simple sleep study


  Involves wearing an oxygen saturation monitor overnight at home
• Respiratory polygraphy


  Involves wearing a machine that monitors respiratory rate, flow rate, saturations, and heart rate, and can usually be done at home
• Complex sleep study


  Involves an overnight stay in a sleep centre with polysomnography, may include monitoring brain activity (EEG), muscle activity (EMG), and heart activity (ECG)
• Management


  Reversible risk factors should be addressed, with reduced alcohol, smoking cessation, and weight loss
• Continuous positive airway pressure (CPAP)


  Machines provide constant pressure to maintain airway patency
• Surgery


  An option involving significant surgical reconstruction of the soft palate and jaw, most common procedure is uvulopalatopharyngoplasty (UPPP)