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Practice Guidelines

Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s: summary of NICE guidance

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2360 (Published 08 November 2021) Cite this as: BMJ 2021;375:n2360
  1. Sharangini Rajesh, senior research fellow1,
  2. David Wonderling, head of health economics1,
  3. Anita K Simonds, clinical lead and honorary consultant in respiratory & sleep medicine2
  4. on behalf of the Guideline Committee
  1. 1National Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Royal Brompton and Harefield Hospital, Guys & St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
  1. Correspondence to: S Rajesh sharangini.rajesh{at}rcp.ac.uk

What you need to know

  • Not all people with obstructive sleep apnoea/hypopnoea syndrome (OSAHS) are sleepy (some are tired, fatigued, or have insomnia), so do not rely exclusively on sleepiness scores for referral

  • Continuous positive airway pressure (CPAP) therapy can reduce symptom burden in people with symptomatic mild OSAHS

  • CPAP therapy remains the first choice of treatment for moderate and severe OSAHS

  • Mandibular advancement splints have a role in symptomatic mild OSAHS and in those with moderate or severe OSAHS who do not tolerate CPAP or decline to try CPAP.

Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) affects around 5% of adults in the UK, while obesity hypoventilation syndrome (OHS) is estimated to affect 0.3-0.4% of the general population.1 In addition to sleepiness, OSAHS may present with a range of symptoms including insomnia and difficulties concentrating, and it can lead to hypertension and exacerbate pre-existing cardiovascular disease. People with OHS are at higher risk of cardiovascular complications and have higher mortality compared with non-obese people.2

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) guideline for obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in adults (over 16 years old).3 The guideline, published in August 2021, covers diagnosis and management of OSAHS, OHS, and COPD-OSAHS overlap syndrome. This guideline summary discusses only selected recommendations on OSAHS and OHS, focusing on those most relevant to primary care.

Recommendations

NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline committee’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Obstructive sleep apnoea/hypopnoea syndrome (OSAHS)

In this condition the upper airway is narrowed or closes during sleep when muscles relax, causing under-breathing (hypopnoea) or stopping breathing …

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