What Is Obstructive Sleep Apnoea?

Overview

Obstructive sleep apnoea (OSA) is one of the most common types of sleep apnoea that occurs due to a disturbance in breathing when someone is asleep which causes the person to snore loudly. It can affect anyone, but people of a certain age and BMI are more likely to have it.¹

This disruption causes the person to feel more tired and sleepy during the day and if not treated can affect your health and well-being. But luckily there are treatments available to help with OSA depending on the level of severity and you should see your doctor if you have symptoms. 

The condition is named as such: 

• Obstructive: there’s a blockage in the mouth and throat (airway)
• Sleep: as it happens during sleep
• Apnoea: when someone stops breathing for 10 seconds or more²

Causes and risk factors

So, what causes OSA?

• Upper airway obstruction: when asleep the throat muscles are usually relaxed and don’t cause much of a problem. In People with apnoea, however, these throat muscles become so relaxed that it causes a narrowing of the airway (hypopnoea) and sometimes a complete block (apnoea) 
• Having large tonsils and neck: this can also cause narrowing of the airway resulting in snoring while apnoea occurs when there is a blockage causing the affected person to stop breathing for around 10 seconds whilst asleep 
• Having a family history: it can be passed on by a family member who also has OSA³

Who is more likely to get OSA?

• Age and gender considerations: studies have shown that anyone over 40 years old or men with a large size neck of more than or around 43cm (approximately 17 inches) are more likely to develop OSA
• Sleep position: people who mostly sleep by lying on their back are more likely to develop OSA. This sleep position can cause the throat muscle to relax too much, thus, causing a narrowing of the airway
• Obesity and its connection to OSA: it is believed that people with obesity or overweight are more likely to have OSA. This is because of the excessive fat around the neck area, which can cause the narrowing of the throat muscles, thereby causing difficulty with breathing³

Symptoms and diagnosis

 Some common symptoms of OSA include: 

• Breathing, stopping for a few seconds and restarting while asleep.
• Loud snoring
• Waking up often during the night
• Snorting or making choking or gasping noises upon waking.
• Feeling tired during the day
• Mood swings (getting upset easily or being depressed)
• Having a headache when you wake up (mostly in the morning)

The list is not exhaustive, and you can ask someone to watch you while you’re asleep so they can tell you if you have the symptoms. The person can help describe your symptoms when you see your doctor about it.³

Importance of early detection

You should speak to your GP if you’re struggling with tiredness during the daytime or have a poor sleep pattern due to some of the main symptoms such as snorting, choking noises, or breath stopping and starting. OSA can lead to more serious health problems if it's not diagnosed and treated early.

Diagnostic tools and sleep studies

It might interest you to know that snoring does not necessarily mean that you have OSA. However, you should speak to your GP if you or someone you know snores loudly with a period of quietness.

If the doctor thinks that you have OSA, you might be referred to a specialist at a sleep clinic for further checks on your heart and how you’re breathing.⁴

The specialist may do a sleep study or use a polysomnography (PSG) (to either use at home or in the clinic) that you will need to wear overnight to check for symptoms while you sleep. It can also tell if your condition is severe based on the AHI score, which classifies the severity of your condition by how often you stop breathing while asleep.⁴

Health consequences

If OSA is left untreated, it can lead to problems in the quality of one’s life as well as one’s health such that one of the major symptoms of snoring can put a strain on the person’s relationship with their sleep-deprived partners. Some of the other possible problems that have been linked to OSA include:

• Impact on cardiovascular health: OSA increases the risk of developing heart problems including high blood pressure or heart attack⁵
• Association with diabetes and metabolic disorders: OSA has also been linked to the risk of developing diabetes due to possible weight issues. Some metabolic disorders such as problems with the thyroid have been linked to people with OSA due to the enlargement of the neck as the thyroid gland is mostly found in the neck area⁵
• Effects on cognitive function and daytime fatigue: some studies have shown that OSA can affect one’s performance during the daytime due to tiredness. In fact, there is some research done that has shown that people with OSA are 12 times more likely to have a car accident as their ability to drive may be affected

It is important to note that the Driver and Vehicle Licensing Agency (DVLA) should be informed if you have a medical condition that may affect your driving. If you have been diagnosed with OSA, you must inform the DVLA and avoid driving until your symptoms are well controlled.

Treatment Options

You will be glad to know that OSA is treatable and there are different options available to help reduce or improve the symptoms. OSA is a long-term condition and these treatment options may be ongoing for a long time. Some of these include:

Lifestyle modifications

This is beneficial as it helps to control your symptoms and makes you feel better naturally. Some of the lifestyle modifications that could be tried are as follows.

Weight management 

Trying to lose weight (if overweight or obese) can be understandably hard, if this feels difficult for you, you can speak to your GP who can refer you to weight management services offered by the NHS.

Positional therapy

Researchers found that most people get OSA from lying on their back. Laying on your side when sleeping has been proven a better way to reduce or stop the symptoms.⁶

Avoidance of alcohol and sedatives

Cutting down on alcohol or avoiding it at least 4-6 hours before bedtime as well as not using sedatives has shown to improve symptoms. Also, if you’re a smoker, you can speak to your GP for help on free local smoking cessation services.

Continuous Positive Airway Pressure (CPAP) therapy

This has been proven to be the most effective treatment for moderate to severe OSA. CPAP is a device that delivers compressed air through a mask to your airway overnight. This helps to prevent your airway from closing while you’re sleeping and thus prevents breathing from stopping and starting.⁷ There’s evidence that CPAP has helped with daytime sleepiness, tiredness, and even lowering blood pressure.

Compliance and challenges with CPAP 

Some people might find using CPAP inconvenient due to problems with the mask fitting, dry nose and nosebleeds, or even throat irritation. Working with your specialist for a management plan that suits your needs with appropriate patient education and support can help with this.

Surgical interventions

Maxillomandibular advancement

This consists of a gum shield-like mouthpiece that is customised to fit the person’s upper and lower teeth to open up the airway and is worn during sleep. This is usually used for people who snore or have mild OSA with no daytime sleepiness and for those who do not respond to or can’t tolerate CPAP.⁸

Upper airway surgery (such as tonsillectomy - removing large tonsils)

This is very rare but can be used to improve the throat muscle tone by unblocking any blockage. It is usually considered if other treatments have failed.⁴ 

Importance of sleep hygiene

One of the things that you can do to help with OSA symptoms is maintaining good sleeping habits. This includes: 

• Create a conducive sleep environment by making sure your room is quiet and mostly dark
• Establish a regular sleep routine like going to bed at a certain time and waking up at the same time each day
• Manage stress and mental health. You should speak to your doctor for help with a care plan to manage it

Epworth Sleepiness Scale test

If you have symptoms of OSA, it is important to speak to your doctor about your concerns. But before you speak to your doctor, you can use the Epworth Sleepiness Scale test to check your sleeping pattern. Another one you can try is the STOP-Bang questionnaire. Either one of these can be taken with you to see your doctor to explain your symptoms. But please note that your GP may not rely on these results alone and would ask you more questions about your symptoms before making a final diagnosis.

Support Group 

If you would like to find out more about OSA, you can visit the following support group for further information and to meet other people with OSA.:

• Sleep Apnoea Trust
• BSSAA for travel advice
• The British Lung Foundation (BLF)

Summary

Obstructive Sleep Apnoea (OSA) is a life-long condition characterised by daytime sleepiness and snoring whilst asleep. OSA can become worse if left untreated. Anyone can develop OSA but some of the common causes of OSA are overweight, obese, being over 40 years old, and being male.

Luckily, there are effective treatments available that could help with the symptoms, and it is important to speak to your GP if you have OSA symptoms.