Obstructive sleep apnoea
Obstructive sleep apnoea
Obstructive sleep apnoea (OSA) is a fairly common condition in which the walls of the throat relax and narrow or close while a person is sleeping. This interrupts normal breathing. It can lead to sleep that is broken up throughout the night, which may:
- affect quality of life, mainly by causing a lot of sleepiness during the day
- raise the risk of developing certain other conditions
Types of OSA
OSA involves 2 types of breathing interruption:
- apnoea: the airway becomes fully blocked for 10 seconds or more
- hypopnoea: the airway becomes partly blocked, causing airflow to drop by more than 50% for 10 seconds or more
People with OSA may go through both apnoeas and hypopnoeas repeatedly during the night. In severe cases, these episodes can happen roughly once every 1 or 2 minutes.
OSA is sometimes referred to as obstructive sleep apnoea-hypopnoea syndrome (OSAHS). This term is used when someone has apnoeas and hypopnoeas throughout the night, along with daytime sleepiness and other symptoms that affect quality of life. OSA and OSAHS refer to the same condition.
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
When to See a Doctor
Speak to your GP practice if:
- you think you might have OSA, especially if you're very sleepy during the day
They can check for other possible reasons for your symptoms and may refer you to a sleep specialist.
Diagnosis
Before you go to see your doctor, it may help to ask a partner, friend or family member to watch you while you sleep, if that's possible. If you have OSA, they may notice pauses in your breathing.
It can also help to fill out an Epworth Sleepiness Scale questionnaire. This asks how likely you are to doze off in different situations, for example while watching TV, sitting in a meeting or driving. Your score on this scale will help your doctor work out whether you may have a sleep disorder.
Your doctor will usually ask you about your symptoms. They may also check your blood pressure and take a blood sample. This helps rule out other conditions that could explain your tiredness, such as an underactive thyroid gland (hypothyroidism) or anaemia.
The next step is usually an overnight assessment known as a sleep study. This checks your sleeping pattern to see whether you have a high number of breathing pauses during the night. It's normal to have a few breathing pauses through the night, but a high number is not. Your doctor can refer you to specialist clinics or hospital departments that investigate and treat sleep disorders.
Observing your sleep
At the sleep centre, specialists may ask about your symptoms and medical history and carry out a physical examination.
This may include measuring your height and weight to work out your body mass index (BMI), as well as measuring the circumference of your neck. This is because being overweight and having a large neck can raise your risk of OSA.
The sleep specialists will then arrange for your sleep to be assessed overnight. This is usually done in one of two ways:
- taking home some monitoring equipment and bringing it back the next day for the team to analyse. This is the more common approach.
- spending the night at the clinic. This is less common.
In most cases, the sleep centre will teach you how to use portable recording equipment at home while you sleep.
The equipment you're given may include:
- a breathing sensor at your nose or mouth
- sensors that monitor your heart rate
- bands placed around your chest
- oxygen sensors placed on your finger
- a small sensor that sticks onto your chin
Together, this equipment records your oxygen levels, breathing movements, heart rate, snoring, and sleeping position through the night.
If more information is needed, you may be asked to spend a night at the sleep centre.
The main test used to assess sleep at a sleep centre is called polysomnography.
During the night, several parts of your body are carefully monitored while you sleep. Bands and small metal discs called electrodes are placed on your skin at different points on your body. Sensors are also placed on your legs, and an oxygen sensor is attached to your finger.
Polysomnography includes several different tests, such as:
- electroencephalography (EEG), which monitors brain waves
- electromyography (EMG), which monitors muscle tone
- recordings of movement in your chest and abdomen
- recordings of airflow through your mouth and nose
- pulse oximetry, which measures your heart rate and blood oxygen levels
- electrocardiography (ECG), which monitors your heart
Sound recording and video equipment may also be used.
If OSA is diagnosed early in the night, you may be started on continuous positive airway pressure (CPAP) treatment. CPAP uses a mask that delivers a steady stream of compressed air to keep your airway open, preventing OSA.
Once testing is complete, the sleep centre team should have a good idea of whether or not you have OSA. If you do, they can work out how much it's affecting your sleep and recommend the right treatment.
Determining the severity of OSA
The severity of OSA depends on how many breathing pauses you have per hour of sleep. These episodes are measured using the apnoea-hypopnoea index (AHI).
Severity is classified as follows:
- mild: an AHI reading of 5 to 14 episodes an hour
- moderate: an AHI reading of 15 to 30 episodes an hour
- severe: an AHI reading of more than 30 episodes an hour
Treatment is most likely to help people with moderate or severe OSA, as well as those who feel very sleepy during the day. That said, treatment can still benefit some people with mild OSA too.
Treatment
There are treatments that can help ease the symptoms of OSA.
Surgery
Surgery may be an option if OSA is thought to be caused by a physical problem that can be corrected this way, for example enlarged tonsil tissue. For most people, surgery is not the right approach. It is usually only considered as a last resort, when other treatments have not helped.
Support groups
OSA can affect quality of life quite significantly, not just for the person who has it but for their friends and family too.
It can lead to physical problems such as tiredness and headaches, and it can also take an emotional toll, affecting relationships with others.
Asthma + Lung UK and the Sleep Apnoea Trust offer support and advice for people living with OSA.
Complications
Complications of OSA
Treatments can often help control the symptoms of OSA, but they’ll need to be lifelong in most cases.
If OSA is left untreated, it can cause problems such as poor performance at work and school, and placing a strain on your relationships.
Poorly controlled OSA may also increase your risk of:
- developing high blood pressure (hypertension)
- having a stroke or heart attack
- developing an irregular heartbeat – such as atrial fibrillation
- developing type 2 diabetes – although it’s unclear if this is the result of an underlying cause, such as obesity
Driving
Someone who has been deprived of sleep because of OSA may be more likely to be involved in a car accident. If you’re diagnosed with OSA, it may mean your ability to drive is affected. You must inform the DVLA about a medical condition that could impact your driving ability.
Once a diagnosis of OSA has been made, you shouldn’t drive until your symptoms are well controlled.
GOV.UK has advice about how to tell the DVLA about a medical condition.
Don’t include personal information e.g. name, location or any personal health conditions.