Sleep Apnoea

What Is Obstructive Sleep Apnoea (OSA)?

Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) affects up to a billion people globally, causing airway blockages and breathing interruptions during sleep. It raises the risk of car accidents, cardiovascular issues, diabetes, mood disorders, and reduces quality of life. Prevalence can exceed 50% in some areas. Treatments include lifestyle changes, CPAP therapy, oral appliances, and surgery, with early diagnosis being crucial.

It is characterised by recurring episodes of upper airway obstruction during sleep for at least 10 seconds or longer.

The upper airway closure is either complete (apnoea) or partial (hypopnea). These episodes, which can occur up to several hundred times during sleep, often lead to micro-arousals which substantially alter the quality of sleep.

Apnoeas and hypopneas are almost always accompanied by loud snoring and are a cause of major stress on the cardiovascular system and other organs.

Symptoms

Often, it’s a partner who notices the signs first, such as loud snoring or pauses in breathing. Other symptoms include:

  • Excessive daytime sleepiness

  • Morning headaches

  • Unexplained fatigue or irritability

  • Choking or gasping during sleep

  • Night sweats

  • Nocturia (frequent night-time urination)

  • Low mood or depression

  • Reduced libido

  • Difficulty concentrating or memory problems

Consequences of Untreated OSAHS

Left untreated, OSAHS can significantly affect physical health, relationships, and quality of life. It can lead to:

  • Poor concentration and reduced cognitive function

  • Higher risk of road traffic and occupational accidents

  • Strain on personal and professional relationships

  • Increased risk of cardiovascular events, obesity, and type 2 diabetes

  • Greater burden on healthcare services

Risk Factors

OSAHS can affect anyone, but certain factors increase the risk:

  • Being over 30, with prevalence increasing with age

  • Anatomical traits (e.g. small jaw, thick tongue, enlarged tonsils)

  • Being overweight or obese

  • Alcohol or sedative use

  • Use of sleeping pills

  • Sleeping on your back

  • Children with enlarged adenoids or tonsils

In Europe alone, an estimated 175 million people may have OSAHS, with around 90 million experiencing moderate to severe forms.

Diagnosis

Polysomnography remains the gold standard for diagnosing sleep apnoea, conducted in-lab or at home to assess sleep quality and breathing. However, long waiting lists for in-lab testing mean many patients are turning to Home Sleep Apnoea Testing (HSAT), which monitors key cardio-respiratory signals during sleep in the comfort of the patient’s home.

New technology now allows accurate diagnosis using mandibular movement sensors and AI, offering faster, less intrusive screening alternatives.

Treatment Options

CPAP (Continuous Positive Airway Pressure) is the most effective and widely prescribed treatment for OSAHS. It delivers a gentle stream of air through a mask to keep the airway open, reducing apnoeas from the first night of use. CPAP therapy is typically provided by NHS Sleep Medicine Services and includes ongoing education and support.

Other options include:

  • Mandibular Advancement Devices (MAD): Custom-fitted dental devices for mild/moderate cases.

  • Positional Therapy: Encourages side-sleeping for position-related apnoea, though long-term compliance is low.

  • Surgery: Considered in rare cases, e.g. for nasal obstructions or enlarged tonsils.

  • Emerging therapies: Myofunctional therapy and hypoglossal nerve stimulation are being explored, but evidence is still limited.

References

  • Benjafield AV et al. Lancet Respir Med. 2019;7(8):687–98.

  • Bjornsdottir E et al. J Sleep Res. 2015;24(3):328–38.

  • Bonsignore MR et al. Multidiscip Respir Med. 2019;14(1):1–2.

  • Patil SP et al. J Clin Sleep Med. 2019;15(2):335–43.

  • Purtle MW et al. Traffic Inj Prev. 2020;21(1):38–41.

  • Morsy NE et al. Rev Environ Health. 2019;34(2):153–69.

  • Moula et al. Clin Med. 2022;11(5):1242.

  • Brown et al. Curr Hypertens Rep. 2022.

  • Javaheri et al. J Am Coll Cardiol. 2017;69:841–58.

  • Yeghiazarians et al. Circulation. 2021;144(3):e56–e67.

  • Reutrakul & Mokhlesi. Chest. 2017;152(5):1070–86.

  • Lopez et al. Am Surg. 2008;74(9):834–8.

  • Malhotra A et al. European OSA prevalence abstract.

  • Thompson C et al. Sci Rep. 2022;12(1):1–1.

  • Savini S et al. Acta Otolaryngol Ital. 2019;39(5):289.

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