Clinical update

Obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is a sleep disorder in which the airway closes, causing a person repeatedly to stop breathing during sleep.

Essential facts

Obstructive sleep apnoea (OSA) is a sleep disorder in which the airway closes, causing a person repeatedly to stop breathing during sleep. It can cause extreme sleepiness during the day and can lead to accidents while driving and in the workplace. It is estimated that about 4% of men and 2% of women in the UK have OSA, although these figures could be higher, according to the British Lung Foundation (BLF).

Picture credit: SPL

The BLF has warned that up to 85% of people with OSA are undiagnosed. The charity has launched a commissioning toolkit that can help healthcare staff determine how many people in their area are undiagnosed and the number of accidents that could be avoided if cases were treated. It provides a checklist for auditing local services and recommendations for treatment. The charity says services vary widely across the UK. An estimated 330,000 adults are currently being treated, out of 1.5 million with OSA.

The key symptoms of OSA are snoring during sleep, stopping breathing or struggling to breathe when asleep, and feeling sleepy when awake. Other symptoms include a feeling of choking and jerky movements when asleep, poor memory, morning headache, loss of sex drive and difficulty concentrating.

Men, women and children can develop OSA, although men are at higher risk. Risk increases with age, and 15-20% of people aged 70 and over are estimated to have the condition. People are more likely to develop OSA if they snore and are overweight or obese. Those with larger necks (over 17 inches), a small airway, a lower jaw that is set back or small, large tonsils, a large tongue, an abnormal face shape or nasal blockage are more at risk.

Take OSA seriously and ask patients who may be affected if they are experiencing sleep problems or other symptoms. Improving diagnosis is crucial: undiagnosed OSA is associated with hypertension, diabetes, stroke and heart disease. It can shorten life expectancy and may lead to accidents, for example, when drivers fall asleep at the wheel. Nurses are in an ideal position to ask patients if they have symptoms of undiagnosed OSA.

Expert comment

Rebecca Sherrington is a British Lung Foundation nurse consultant in respiratory medicine

‘Most people are relieved to get their diagnosis, because living with OSA can seriously affect a person’s quality of life, their health and their ability to work. Improvement in wellbeing is significant following diagnosis and treatment.

‘Every nurse needs to know that OSA is not a small, highly specialist problem and with the current low levels of awareness, many people are likely to be undiagnosed. Support and education from the nurse at the point of diagnosis and establishing treatment is absolutely crucial to patients’ OSA self-management.

‘Although continuous positive airway pressure is a highly effective treatment, patients may have difficulty adapting and adhering to therapy.’

Find out more

British Lung Foundation obstructive sleep apnoea (OSA) toolkit

Epworth Sleepiness Scale, used to diagnose OSA

Government advice on OSA and driving

NICE guidance: Continuous positive airway pressure treatment for OSA

Sleep Apnoea Trust

Clinical digest: Reducing the risk of cardiovascular mortality among sleep apnoea patients (October 2013)

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