AKT · ENT/Throat & airwaylow yield

Obstructive sleep apnoea

Repetitive upper-airway collapse during sleep

Overview

Recurrent collapse of the upper airway during sleep causing apnoeas/hypopnoeas, fragmented sleep and intermittent hypoxia. Snoring with witnessed apnoeas and daytime sleepiness in an overweight, often middle-aged patient. In children the usual cause is adenotonsillar hypertrophy. Important because of its cardiovascular consequences and the driving risk.

Recognise

Loud snoring, witnessed apnoeas/choking, and unrefreshing sleep with excessive DAYTIME sleepiness (Epworth score)
Risk factors: obesity (large neck circumference), male, middle age, alcohol/sedatives, retrognathia; children → enlarged tonsils/adenoids
Associations/consequences: hypertension (often resistant), atrial fibrillation, type 2 diabetes, and road-traffic-accident risk

Red flags

Falling asleep while driving/at work; resistant hypertension; pulmonary hypertension/cor pulmonale; a sleepy driver must not drive and must inform the DVLA

Differentials & how to tell them apart

Simple snoring (no apnoea)snoring without apnoeas, hypoxia or daytime sleepiness — a sleep study separates them

Hypothyroidismfatigue/somnolence with thyroid features — check TFTs

Narcolepsysleep attacks ± cataplexy, not airway obstruction

Depression/poor sleep hygienetiredness without snoring/apnoea or hypoxia

Investigations

Epworth Sleepiness Scale to quantify; refer for sleep study (oximetry / polysomnography) to confirm and grade (apnoea-hypopnoea index). Assess cardiovascular risk and BP.

Management

Weight loss + CPAP for moderate–severe disease (adenotonsillectomy in children)

1Lifestyle measures (weight loss, reduce alcohol/sedatives, sleep position) for all; confirm and grade with a sleep study. Moderate–severe OSA → CPAP (the mainstay).Gate: Advise on DRIVING — a sleepy driver must stop driving and inform the DVLA until treated; and in CHILDREN the cause is usually adenotonsillar hypertrophy, so the treatment is adenotonsillectomy, not CPAP
2CPAP-intolerant or mild disease → mandibular advancement device; treat associated hypertension and cardiovascular risk; ENT/sleep-service follow-up.

Weight loss, alcohol/sedative avoidance, sleep position — first-line lifestyle measures for all

CPAP (continuous positive airway pressure) — the mainstay for moderate–severe OSA — splints the airway open

Mandibular advancement device — mild–moderate disease or CPAP-intolerant

Adenotonsillectomy — first-line in CHILDREN with adenotonsillar hypertrophy

Key points

Snoring + witnessed apnoeas + daytime sleepiness + obesity = OSA → sleep study + CPAP. The two exam pivots: the DVLA/driving advice, and that children are treated by removing the tonsils/adenoids.

Monitor & prognosis

Epworth/symptoms, CPAP adherence, BP and cardiovascular risk.

CPAP markedly improves symptoms and risk when used; untreated OSA raises cardiovascular and accident risk.

Source: NICE NG202 (OSA); SIGN; ENT UK