Practice Easily Missed?

Obstructive sleep apnoea in adults

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b1165 (Published 07 April 2009) Cite this as: BMJ 2009;338:b1165
  1. Sophie D West, consultant1,
  2. Helen A McBeath, general practitioner2,
  3. John R Stradling, professor1
  1. 1Sleep Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford OX3 7LJ
  2. 2St Clements Surgery, Oxford OX4 1JS
  1. Correspondence to: S D West sophie{at}west66.freeserve.co.uk

    Case scenario

    A 50 year old long distance lorry driver attends for a review of his heavy goods vehicle licence. His body mass index is 30, and he says his wife complains that he snores loudly. The history of loud snoring in this overweight man should raise concern about possible obstructive sleep apnoea. As he is a lorry driver this diagnosis is particularly important.

    Obstructive sleep apnoea is characterised by snoring, recurrent episodes of upper airway obstruction during sleep (apnoeas and hypopnoeas), and arousals. The resulting sleep disturbance can cause excessive and disabling daytime sleepiness. The term obstructive sleep apnoea syndrome is used for people who have features of obstructive sleep apnoea on a sleep study and also have resulting daytime sleepiness.

    How common is it?

    • Prevalence varies according to the population studied

    • In the US state of Wisconsin a cohort study of 30-60 year old workers found that 24% of men and 9% of women had evidence of obstructive sleep apnoea (at least five apnoea or hypopnoea events per hour).1 This study estimated that only 4% of men and 2% of women reported any daytime sleepiness also (that is, obstructive sleep apnoea syndrome)

    • In a UK study, with lower levels of obesity, the prevalence of obstructive sleep apnoea syndrome in men was about 1%2

    • These studies show that obstructive sleep apnoea is a common problem, which is likely to increase further as obesity levels rise

    • Selected populations show a higher prevalence of obstructive sleep apnoea—for example, 23% of men with type 2 diabetes were estimated to have appreciable obstructive sleep apnoea.3 Estimates suggest that 59 400 people receive continuous positive airway pressure treatment in England (0.2% of the population); but the National Institute for …

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