2 Clinical need and practice

2 Clinical need and practice

2.1 Apnoea is defined as a temporary absence or cessation of breathing. OSAHS is a condition in which a person experiences repeated episodes of apnoea because of a narrowing or closure of the pharyngeal airway during sleep. This is caused by a decrease in the tone of the muscles supporting the airway during sleep. Complete closure (obstruction) stops airflow (apnoea) whereas partial obstruction decreases airflow (hypopnoea). OSAHS results in episodes of brief awakening from sleep to restore normal breathing.

2.2 Moderate to severe OSAHS can be diagnosed from patient history and a sleep study using oximetry or other monitoring devices carried out in the person's home. In some cases, further studies that monitor additional physiological variables in a sleep laboratory or at home may be required, especially when alternative diagnoses are being considered. The severity of OSAHS is usually assessed on the basis of both severity of symptoms (particularly the degree of sleepiness) and the sleep study, by using either the apnoea/hypopnoea index (AHI) or the oxygen desaturation index. OSAHS is considered mild when the AHI is 5–14 in a sleep study, moderate when the AHI is 15–30, and severe when the AHI is over 30. In addition to the AHI, the severity of symptoms is also important.

2.3 The symptoms of OSAHS include impaired alertness, cognitive impairment, excessive daytime sleepiness, snoring, nocturia, morning headaches and sexual dysfunction. The sleep quality of partners may also be affected. Excessive daytime sleepiness can adversely affect cognitive function, mood and quality of life. OSAHS is associated with high blood pressure, which increases the risk of cardiovascular disease and stroke. OSAHS has also been associated with an increased risk of road traffic accidents.

2.4 Major risk factors for developing OSAHS are increasing age, obesity and being male. OSAHS is also associated with certain specific craniofacial characteristics (such as retrognathia), enlarged tonsils and enlarged tongue. Use of alcohol or sedatives can also increase the risk or severity of the condition. OSAHS has been reported to affect up to 4% of middle-aged men and 2% of middle-aged women in the UK. It is estimated that 1% of men in the UK may have severe OSAHS.

2.5 Treatments aim to reduce daytime sleepiness by reducing the number of episodes of apnoea/hypopnoea experienced during sleep. The alternatives to CPAP are lifestyle management, dental devices and surgery. Lifestyle management involves helping people to lose weight, stop smoking and/or decrease alcohol consumption. Dental devices are designed to keep the upper airway open during sleep. The efficacy of dental devices has been established in clinical trials, but these devices are traditionally viewed as a treatment option only for mild and moderate OSAHS. Surgery involves resection of the uvula and redundant retrolingual soft tissue. However, there is a lack of evidence of clinical effectiveness, and surgery is not routinely used in clinical practice.