Obstructive sleep apnoea

Definition: A condition characterised by repetitive episodes of upper airway obstruction during sleep, leading to reduced or absent airflow despite ongoing respiratory effort.

• Obesity, particularly central obesity.
• Male gender.
• Neck circumference: larger necks may have more soft tissue that can obstruct the airway.
• Enlarged tonsils or adenoids.
• Family history of OSA.
• Use of alcohol or sedatives which relax the airway muscles.
• Smoking: potential to increase inflammation and fluid retention in the airway.
• Endocrine disorders such as hypothyroidism or acromegaly.
• Structural features: recessed chin, deviated nasal septum, and craniofacial abnormalities.

• Snoring: Often loud and disruptive.
• Witnessed apnoeic episodes during sleep.
• Chronic daytime fatigue and sleepiness.
• Difficulty concentrating.
• Morning headaches.
• Restless sleep or insomnia.
• Nocturia.
• Mood changes: depression, irritability.

• Polysomnography (PSG): Gold standard. A sleep study that monitors various body functions during sleep, including brain electrical activity, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels.
• Oximetry: May be used as a screening tool but less accurate than PSG.
• Epworth Sleepiness Scale: Subjective measure of daytime sleepiness.

• Continuous Positive Airway Pressure (CPAP): Delivers air pressure through a mask placed over your nose while you sleep, keeping the airway passages open.
• Dental devices: Especially for mild cases; reposition the lower jaw and tongue.
• Lifestyle changes:
  • Weight loss if overweight.
  • Positional therapy if apnoeas occur mostly when lying on the back.
  • Avoiding alcohol and sedatives before bedtime.
• Surgical options:
  • Tonsillectomy or adenoidectomy.
  • Uvulopalatopharyngoplasty (removal of excess tissue from the throat).
  • Maxillomandibular advancement (repositioning of the upper and lower jaw).
  • Inspire therapy (implantable device that stimulates the hypoglossal nerve).
  • Tracheostomy: For severe, life-threatening OSA.

• Cardiovascular problems: hypertension, coronary artery disease, abnormal heart rhythms.
• Type 2 diabetes.
• Metabolic syndrome.
• Complications with medications and surgery due to decreased oxygen levels.
• Liver function abnormalities.
• Daytime fatigue leading to accidents.

• OSA is a serious condition that can have a wide range of cardiovascular, metabolic, and neurocognitive complications.
• Early recognition and appropriate management can significantly reduce morbidity and improve quality of life.