Sleep Apnoea
Obstructive sleep apnoea (OSA) is a common and underdiagnosed condition in which the upper airway repeatedly collapses during sleep, causing interruptions in breathing (apnoeas, lasting at least 10 seconds) or significant reductions in airflow (hypopnoeas). These events are associated with oxygen desaturation and, crucially, with arousal from sleep — which the sleeper is usually unaware of but which prevents restorative sleep architecture from being achieved. In moderate to severe OSA, hundreds of these events can occur per night.
Why it matters
Beyond the obvious consequence of non-restorative sleep and excessive daytime sleepiness, OSA has serious cardiovascular implications. Repeated cycles of hypoxia and reoxygenation, along with surges in sympathetic nervous system activity and blood pressure during each arousal, place sustained stress on the cardiovascular system. OSA is an independent risk factor for hypertension (present in over 50% of those with OSA), atrial fibrillation, coronary artery disease, stroke, and heart failure. It also significantly impairs cognitive function, mood, and — of particular public safety concern — increases the risk of road traffic accidents due to sleepiness at the wheel.
Who is affected?
OSA is considerably more common in men than women, though the difference narrows after the menopause. Obesity is the strongest modifiable risk factor — excess adipose tissue around the neck and pharynx narrows the upper airway. Other risk factors include increasing age, a receding jaw or large tongue, enlarged tonsils or adenoids (particularly in children), nasal obstruction, alcohol and sedative use (which further relax pharyngeal muscles), smoking, and hypothyroidism.
Symptoms
The classic presentation involves loud snoring (often reported by a bed partner), witnessed apnoeas during sleep, and excessive daytime sleepiness. Other common features include unrefreshing sleep, morning headaches, nocturia, difficulty concentrating, irritability, and low mood. Some patients — particularly women — present atypically with fatigue and mood symptoms rather than the classic snoring and sleepiness.
Choosing where to be treated
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