Obstructive sleep apnoea (OSA): what it is, symptoms, tests and treatment

NICE Clinical Knowledge Summaries describes obstructive sleep apnoea/hypopnoea syndrome as recurrent episodes of complete or partial blockage of the upper airway during sleep. A complete blockage stops airflow (apnoea) and a partial one reduces it (hypopnoea). The cycle repeatedly rouses the sleeper briefly to restore muscle tone and airflow. The cause, according to CKS, is collapsing forces around the throat that exceed the reduced muscle tone during sleep.

The NHS describes sleep apnoea as breathing that stops and starts during sleep, with obstructive sleep apnoea the most common type, and notes that it needs treatment because it can lead to more serious problems. It affects all age groups, with prevalence rising with age and weight, CKS adds. Central sleep apnoea is a different condition and is covered on its own page.

The symptoms mainly happen during sleep, which makes OSA easy to miss. The NHS suggests asking someone to stay with you while you sleep to check, or bringing the person who has noticed symptoms to the GP.

• Your breathing stopping and starting, and gasping, snorting or choking noises.

• Waking up a lot, and loud snoring.

• During the day: feeling very tired, finding it hard to concentrate, mood swings.

• A headache when you wake up.

Lifestyle change can sometimes be enough, particularly in mild OSA. The NHS suggests losing weight if overweight, exercising, keeping to good sleep habits, sleeping on your side (for example with a tennis ball taped to the back of sleepwear or a special pillow), not smoking, avoiding too much alcohol particularly shortly before bed, and not taking sleeping pills unless a doctor recommends them, because they can make sleep apnoea worse.

Many people need a CPAP machine. It gently pumps air into a mask worn over the nose, or nose and mouth, to stop the airway narrowing, which improves sleep quality, reduces tiredness and reduces the risk of problems such as high blood pressure. The NHS says it is provided free on the NHS if needed, may feel strange at first and works best used every night, and that you should tell your doctor if it is uncomfortable or hard to use.

The NHS lists other options sometimes used: a gum-shield-like mandibular advancement device that holds the airway open, surgery such as removing large tonsils, exercises for the mouth and face muscles, and a device that sends small electrical signals to the nerve controlling the tongue (hypoglossal nerve stimulation). CKS lists CPAP and intra-oral devices as the specialist treatments for primary care to encourage.

The NHS says sleep apnoea happens when the airways become too narrow during sleep, and lists these links: obesity, having a large neck, getting older (though children and young adults can get it), other family members with sleep apnoea, drinking alcohol, smoking, large tonsils or adenoids, sleeping on your back, and COPD. NICE CKS also lists male sex, nasal or throat obstruction, craniofacial abnormalities and neuromuscular disorders.

A GP assesses symptoms, risk factors and effect on daily life, and may check blood pressure, body mass index and neck circumference, and use a screening questionnaire, according to CKS. If sleep apnoea is suspected, the NHS says the GP may refer you to a specialist sleep clinic for tests. You are given devices that record breathing and heartbeat overnight; this can usually be done at home, though sometimes an overnight stay is needed.

The results show whether you have sleep apnoea and how severe it is, based on the apnoea-hypopnoea index (AHI), which measures how often breathing stops or reduces per hour of sleep. CKS says referral is urgent if sleepiness affects professional drivers or safety-critical workers, or if OSA can worsen another heart or lung condition, in pregnancy, before major surgery, and in some other circumstances, and routine if symptoms are moderate or severe, or mild but affecting quality of life.

The NHS says that children and young adults can also get sleep apnoea, and lists large tonsils or adenoids as a link. NICE CKS says signs in children include witnessed snoring and pauses in breathing, arousals from sleep, laboured breathing, bedwetting at night (nocturnal enuresis), mouth breathing, behavioural problems and reduced school performance. It also says that OSA may be associated with reduced concentration and faltering growth in children.

CKS advises that a child with suspected OSA is referred to a paediatric ear, nose and throat specialist if there is nasal or throat obstruction and snoring at night, or to a paediatrician if there is a congenital or developmental disorder, an associated condition, or obesity contributing to symptoms. If you are worried that your child stops breathing in their sleep, see your GP.

The NHS says untreated sleep apnoea can lead to high blood pressure, a higher chance of stroke, type 2 diabetes, heart disease, depression or mood changes, accidents caused by tiredness and trouble concentrating at work or school. CKS also links OSA with cardiometabolic conditions and road traffic collisions. It can strain relationships with a partner.

On driving, the NHS says you may need to tell the DVLA about your sleep apnoea. If sleep apnoea with excessive sleepiness has been confirmed, you must not drive until symptoms such as feeling very tired are under control. CKS also advises about when to tell an employer where the job is safety-critical. Check the current rules on GOV.UK.

The NHS says to see a GP if you have any of the main symptoms: your breathing stops and starts while you sleep, you make gasping, snorting or choking noises while you sleep, or you always feel very tired during the day. If someone else has seen the symptoms, it can help to bring them with you. It adds that sleep apnoea can be serious if it is not diagnosed and treated.

NICE CKS advises that referral to a sleep clinic is urgent when sleepiness affects professional drivers or safety-critical workers, when OSA can worsen another heart or lung condition, in pregnancy, and before major surgery. If you are falling asleep while driving, do not drive and speak to a doctor promptly.

On the NHS, your GP assesses symptoms and refers you to a sleep clinic, where devices that record breathing and heartbeat overnight are usually used at home. The NHS says a CPAP machine is provided free on the NHS if you need it, and that it works best if used every night.

Some people choose to see a sleep specialist or arrange a home sleep study privately. Whichever route you take, share the results with your GP, because treatment only works if used consistently and review of how it is going matters.