Multiple pauses in respiration (‘apnoeas’) during sleep, as a result of upper airway collapse, usually at the level of the oropharynx
Aetiology
Occurs most often in overweight, middle-aged men
Causes other than obesity include: enlarged tonsils/adenoids, retrognathia, acromegaly, hyperthyroidism, oropharyngeal deformity, neurological (e.g. stroke), drugs (depressants) and anaesthesia (post-op period)
Pathophysiology
Apnoeas occur when the airway at the back of the throat is sucked closed when breathing in during sleep
Apnoea leads to hypoxia and increasingly strenuous respiratory efforts until the patient overcomes the resistance
The combination of central hypoxic stimulation and the effort to overcome obstruction wakes the patient from sleep
These awakenings are so brief that patients remain unaware of them but may be woken hundreds of times per night, leading to sleep deprivation with consequent daytime sleepiness and impaired intellectual performance
Clinical presentation
Excessive daytime sleepiness which majorly impacts daytime function
Can be measured using the Epworth Sleepiness Scale
Loud snoring
Unrefreshed, restless sleep
Investigations
Overnight sleep study - oximetry, domiciliary reading, full polysomnography (gold standard)
Management
Correction of treatable factors, including encouraging weight loss and alcohol reduction
CPAP should be offered to patients with daytime sleepiness
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