Sleep Apnoea: Recognising It and Getting Assessed
Obstructive sleep apnoea involves repeated partial or complete airway closure during sleep, causing oxygen levels to fall and brief arousals that fragment sleep without the person waking properly.
It is common, and a large proportion of cases go undiagnosed because the symptoms are attributed to age, weight or stress.
What to look for
Loud habitual snoring, frequently with observed pauses in breathing followed by a gasp or snort. Partners usually report this before the patient notices anything.
Excessive daytime sleepiness — falling asleep watching television, in meetings, or dangerously while driving.
Waking unrefreshed despite adequate time in bed.
Morning headaches, dry mouth, and needing to urinate during the night.
Irritability, poor concentration and low mood, which are frequently attributed to other causes.
Why it matters
Untreated apnoea is associated in research with hypertension, cardiovascular disease, type 2 diabetes and stroke.
The daytime sleepiness carries immediate risk, particularly for driving. Many jurisdictions require notification to the licensing authority where sleepiness affects driving, and treatment usually resolves the restriction.
It also affects the partner's sleep substantially, which is frequently what prompts the consultation.
Risk factors
Excess weight, particularly around the neck, is the strongest modifiable factor.
Male sex, increasing age, large neck circumference, and anatomical factors such as a receding jaw or enlarged tonsils.
Alcohol and sedatives relax the airway musculature and worsen it.
Menopause increases risk in women, and apnoea in women is frequently missed because presentation differs.
Assessment
Diagnosis requires a sleep study, which may be a home-based overnight recording of oxygen levels, airflow and effort, or a laboratory study for complex cases.
Referral usually comes through a primary care clinician, and describing the symptoms clearly — particularly witnessed pauses — is what triggers it.
Screening questionnaires exist and are used to prioritise, and they are not a substitute for the study.
Treatment
Continuous positive airway pressure is the most effective treatment for moderate to severe cases, delivering pressurised air through a mask to hold the airway open.
Adherence is the main difficulty, and mask fit and humidification make a substantial difference. Persisting through the first weeks is what determines success, and support from the clinic matters.
Mandibular advancement devices, fitted by a dentist, suit mild to moderate cases and some who cannot tolerate CPAP.
Weight reduction, positional therapy for those affected mainly when supine, and avoiding alcohol before bed all help.
The improvement in daytime function with effective treatment is frequently dramatic, which is why pursuing diagnosis is worthwhile.
This article is general information and not medical advice. Consult a qualified healthcare professional.
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