Clinical Review

Obstructive sleep apnoea

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3745 (Published 17 June 2014) Cite this as: BMJ 2014;348:g3745
  1. Michael Greenstone, consultant1,
  2. Melissa Hack, consultant2
  1. 1Castle Hill Hospital, Cottingham, East Yorkshire HU16 5JQ, UK
  2. 2Royal Gwent Hospital, Newport, Gwent, UK
  1. Correspondence to: M Greenstone mike.greenstone{at}hey.nhs.uk

Summary points

  • Obstructive sleep apnoea syndrome (OSAS) is a common and under-recognised cause of excessive daytime sleepiness

  • It can be easily and effectively treated

  • General practitioners play an important role in identifying symptoms and referring appropriately

  • The risk of road traffic incidents is increased in untreated patients with OSAS

  • OSAS may be a modifiable factor for vascular disease

Although snoring and occasional apnoeic breath holding in sleep (obstructive sleep apnoea) is common, the diagnosis of obstructive sleep apnoea syndrome (OSAS) requires the presence of repetitive apnoeas and symptoms of sleep fragmentation, most commonly excessive daytime sleepiness. With increasing awareness of OSAS and portable diagnostic equipment, OSAS is no longer an esoteric diagnosis made only in specialist sleep centres but an easily recognised condition for which effective treatment is widely available. Obstructive sleep apnoea syndrome is also important from a public health perspective because of the increased risk of cardiovascular morbidity1 and road traffic incidents.2 This review is intended for non-specialists and describes the physiology and diagnosis of OSAS, the practicalities of treatment, and the identification of those patients who are likely to benefit.

Sources and selection criteria

We based this review on articles found by searching PubMed and the Cochrane Database of Systematic Reviews. Search terms included “obstructive sleep apnoea or obstructive sleep apnoea syndrome” and “driving or treatment”. The search was limited to articles in English and to studies carried out in adults. We gave priority to data from meta-analyses, reviews, and randomised controlled trials. We also included relevant reports and national guidelines.

What are apnoeas and how common is obstructive sleep apnoea?

Conventionally, an apnoea is a cessation of airflow for 10 seconds and is often associated with oxygen desaturation, whereas a lesser reduction in airflow is termed a hypopnoea. Sleep studies measure the apnoea/hypopnoea index (AHI), which is the number of respiratory events an hour. Community studies have used questionnaires and …

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