Obstructive Sleep Apnoea Syndrome (OSA)
- The adult sleep clinic in the respiratory department is primarily geared towards sleep disordered breathing, obstructive and central sleep apnoea. Parasomnias and suspicion of narcolepsy or nocturnal epilepsy should be referred to adult neurology colleagues
- Apnoeas in sleep – up to 5 per hour – are normal
- Refer individuals with an Epworth score >10/24
- Do not refer patients with simple snoring
This is the combination of BOTH the symptoms from sleep fragmentation AND a supportive sleep study
- Excessive daytime sleepiness
- Poorly refreshing sleep, despite seemingly having an adequate time asleep
- History of heavy snoring
- Witnessed apnoeas
- Sometimes waking with choking/coughing episodes
- Upper body obesity, neck size ≥ 17ins and/or
- Relative retrognathia
- Enlarged tonsils (more often relevant in children)
There is ever increasing evidence that OSAS interacts with, and predisposes to other comorbidities such as diabetes mellitus and hypertension, and leads to poor cardiovascular outcomes (e.g. a strong association with severe bradyarrhythmias requiring a pacemaker & debilitating or fatal stroke)
Option 1 – Lifestyle Measures
- Weight loss where relevant (BMI >25kg/m2, neck size ≥ 17ins)
- Reduce/stop evening alcohol, reduce sedative medications if possible
- Stop smoking (reduces muscular tone)
- Sleep semi propped up
- If nasal pathology present or suspected, maintain maximal nasal patency (nasal steroids)
- Sleep on side as much as possible
- Maximize sleep hygiene (regular bedtime/getting up time, avoiding napping, etc.)
- Symptomatic patients, particularly those with potential driving issues, should not have their referral delayed in the hope that the above might work
- Check thyroid function – an easily reversible cause of OSA
Option 2 – Mandibular Advancement Devices (MADs)
- Mandibular advancement devices can be effective for simple snoring and mild OSA
- They are not in general funded by the NHS, do not require a prescription and must be purchased by the patient. This can be through dental professionals and over the internet, and vary considerably in price.
- If the individual is considering an online purchase of a device we would recommend that they do this through the ‘British Snoring and Sleep Apnoea Association’ web site.
Option 3 – CPAP
- Please refer patients who have symptoms from sleep fragmentation due to sleep disordered breathing or significant comorbidity (eg DM, hypertension) for sleep study and assessment for CPAP therapy
- No other therapy has been shown to consistently abolish the symptoms of OSAS
- Refer when symptoms interfere sufficiently with quality of life (usually excessive sleepiness, affecting work, social activities, and driving), by standard referral letter + completed patient questionnaire.
- Excessive sleepiness can be subjectively and qualitatively assessed using the Epworth Sleepiness score, >10/24 considered significant
- Document whether the patient is a driver, socially or professionally, also if standard or HGV license. Please document if you have given the patient driving advice, (and you may wish to refer to BTS/DVLA statement in this area – see appendix).
- Patients who are clinically obese should be offered referral for weight management support through local services such as ‘Southampton Healthy Living’ and ‘Weight Watchers’.
- Patients who smoke should be offered referral for smoking cessation advice and support through ‘Southampton Health Living’ and ‘Quit4Life’
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