Synopsis
Identify clinically important obstructive sleep apnoea, choose an appropriate sleep study, and link symptom control, cardiovascular risk, device adherence and driving safety.
- OSAHS is recurrent upper-airway narrowing or collapse during sleep causing apnoeas, hypopnoeas, arousal and often intermittent hypoxaemia.
- Ask about witnessed pauses, choking, loud snoring, unrefreshing sleep, morning headache, nocturia, impaired concentration, irritability and daytime sleepiness rather than snoring alone.
- Risk rises with obesity, male sex, age, craniofacial or upper-airway anatomy, alcohol, sedatives and endocrine or neurological conditions, but lean people can also have important OSAHS.
Key red flags
Unintended sleep during conversation, work or driving, near-misses and reduced vigilance indicate functional danger; ask directly because patients may use caffeine or activity to conceal symptoms.
Investigation priorities
Estimate pre-test probability, impairment and urgency.
Management branches
Snoring, witnessed events, non-restorative sleep or daytime impairment suggests OSAHS.
- Document nocturnal events, sleep opportunity, daytime sleepiness, near-misses, occupation, licence group, alcohol, medicines and relevant comorbidity.
- Advise immediate driving cessation when sleepiness could impair driving and explain current DVLA responsibilities without promising a licensing outcome.
Key medicines
Continuous positive airway pressure therapyUse the sleep-service-selected fixed or auto-adjusting pressure every time the person sleeps, with the fitted mask and humidification plan.
Customised mandibular advancement splintWear the dentist-fitted, progressively titrated device during sleep according to the sleep and dental team's individual schedule.