Top tips for GPs and primary care

Obstructive sleep apnoea (OSA) is common and treatable, yet is often undiagnosed.

It is estimated that up to 80% of cases may be undiagnosed (Lee et al 2008).

Prevalence

Up to 4 per cent of middle-aged men and 2 per cent of middle-aged women in the UK have OSA with symptoms. Older people are even more at risk, with 15 to 20 per cent of those aged 70 and over estimated to have the condition.

This means that OSA is more common than severe asthma. The number of people affected by OSA could also be rising due to more people being overweight.

However, up to 80 per cent of people with OSA have not yet been diagnosed.

OSA also affects up to 3 per cent of children, most of whom have large tonsils. OSA is more common among children with certain disabilities, such as Down’s syndrome, and in very obese children.

The BLF uses the term Obstructive Sleep Apnoea to describe the condition including symptoms, as this is the term most commonly used.

Risks

Having undiagnosed OSA may increase the risk of hypertension, stroke and cardiac arrest, and OSA is associated with Type 2 diabetes.

Undiagnosed individuals are more at risk of having road traffic accidents – the DVLA estimates 20% of serious RTAs on major roads are caused by sleepy drivers. The IMPRESS service specification on OSA (2009) says individuals with uncontrolled OSAS have an increased rate of having RTAs of 3-7 times that of general driving population.

Core symptoms

Snoring when asleep
Stopping breathing or Struggling to breathe when asleep
Sleepiness (excessive) when awake

We call this The Triple S (based on Downey 2011)

Contributory factors and early recognition

OSA affects men, women and children. Patients who are most at risk include middle-aged overweight men, post-menopausal women and children with enlarged tonsils.

Other physical attributes that increase risk include macroglossia and retrognathia and anything else that restricts upper airway patency.

The impact of OSA can be very severe for patients and their partners, and can severely impair quality of life.

Treatment

NICE guidelines on the treatment of OSA (2008) state that Continuous Positive Airway Pressure (CPAP) is recommended for adults with moderate to severe symptomatic OSAS.

CPAP is cost-effective – the machine costs about £250 (should last at least 5 years) and the facial mask about £100 per year.

Other treatments include Mandibular Advancement Devices (for mild OSA) and lifestyle changes, including weight loss and sleep hygiene.

Outcomes

CPAP is associated with more quality of life years and lower costs than non-treatment (NICE guidelines 2008). By comparison, the cost of one fatal RTA is estimated to be up to £1,500,000 (Mackay 2010).

“Treating some-one with sleep apnoea is so rewarding – it is a life-changer.” Andrew Meredith, Director of Sleep Disorder Service

“Treatment saves marriages – I call it my happy clinic.” Professor Stephen Spiro, Professor of Respiratory Medicine

What we're asking GPs to do

  • Look for risk factors and signs of early OSA in your patients and give advice about lifestyle changes
  • Use the Epworth Sleepiness Scale on the BLF website to screen patients who present with snoring and daytime sleepiness
  • Take a case history, asking patients who present with snoring or sleepiness to give details of their day-time AND night-time symptoms
  • Refer symptomatic patients to your local sleep clinic/service
  • Ask the patient to contact the British Lung Foundation for more information

If you would like to become involved in the project, or require any further information, please contact OSA@blf.org.uk

Downloads

OSA - A guide for GPs - This helpful leaflet for GPs gives more information about OSA, and includes a simple screening tool

Download OSA - A guide for GPs (PDF 1.28MB)

OSA awareness poster - Download and print this poster to help raise awareness in your surgery.

Download the OSA awareness poster (PDF 1.76MB)