EN4.29 | Obstructive Sleep Apnea — Summary & Reflection

KEY TAKEAWAYS

Obstructive sleep apnea is characterised by repeated pharyngeal airway collapse during sleep causing apnoeas, intermittent hypoxaemia, and sleep fragmentation. Key symptoms: loud snoring, witnessed apnoeas, excessive daytime somnolence (EDS — Epworth Sleepiness Scale ≥10), morning headache, and unrefreshing sleep. Risk factors: male sex, obesity (BMI >30), neck circumference >43 cm (men), retrognathia, alcohol, and nasal obstruction. Diagnosis by polysomnography — AHI: mild 5–15, moderate 15–30, severe >30. Major systemic complications: resistant hypertension, coronary artery disease, atrial fibrillation, T2DM, stroke, and road traffic accidents. Management: weight loss + positional therapy + CPAP (gold standard for moderate-severe OSA) + mandibular advancement device (alternative for mild-moderate or CPAP-intolerant) + surgery (adenotonsillectomy in children; UPPP or maxillomandibular advancement in selected adults). CPAP is a pneumatic splint — immediate elimination of apnoeas on first night. Professional drivers with untreated severe OSA are a driving safety risk and must be advised accordingly.

REFLECT

Think about the systemic consequences of OSA — hypertension, coronary disease, diabetes, road traffic accidents — and reflect on how many patients you will encounter in your career with treatment-resistant hypertension or unexplained atrial fibrillation who have never been asked about their sleep. The most powerful screening questions for OSA take less than 30 seconds: 'Do you snore? Does your partner say you stop breathing? Do you feel tired during the day despite sleeping?' Commit these three questions to memory and ask them in every consultation where cardiovascular or metabolic disease is present. The diagnosis of OSA is often made by a junior doctor who thought to ask about sleep when a senior consultant did not.