Obstructive Sleep Apnoea (OSA)

Question 1

What is obstructive sleep apnoea (OSA)?

Answer 1

Obstructive sleep apnoea is caused by collapse of the pharyngeal airway. It is characterised by episodes of apnoea during sleep, where the person stops breathing periodically for up to a few minutes. The partner usually reports this happening, and the patient is unaware of the episodes.

Question 2

What are the risk factors for OSA?

Answer 2

• Middle age
• Male
• Obesity
• Alcohol
• Smoking

Question 3

What are the clinical features of OSA?

Answer 3

• Episodes of apnoea during sleep (reported by their partner)
• Snoring
• Morning headache
• Waking up unrefreshed from sleep
• Daytime sleepiness
• Concentration problems
• Reduced oxygen saturation during sleep

Question 4

In severe cases, what can OSA lead to?

Answer 4

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

Question 5

Briefly describe The Epworth Sleepiness Scale

Answer 5

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

Question 6

What important questions needed to be asked in the history of OSA?

Answer 6

If interviewing someone you suspect has obstructive sleep apnoea, ask about daytime sleepiness and occupation. Daytime sleepiness is a crucial 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 an urgent referral and may need amended work duties whilst awaiting assessment and treatment.

Question 7

How is OSA investigated and diagnosed?

Answer 7

Patients with obstructive sleep apnoea require referral to an ENT specialist or a specialist sleep clinic to perform sleep studies. This involves the patient sleeping in a laboratory whilst staff monitor their oxygen saturation, heart rate, respiratory rate and breathing to establish any episodes of apnoea and the extent of their snoring.

Question 8

Briefly describe the management of OSA

Answer 8

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 reconstruction of the soft palate and jaw. The most common procedure is called uvulopalatopharyngoplasty (UPPP).