Getting the right treatment for sleep disorders is vital for patient welfare.
Obstructive sleep apnoea (OSA) is one of the most common respiratory disorders. And due to our ageing population and high levels of obesity, it’s prevalence is increasing. But OSA often goes undiagnosed in the general population, and vital questions remain about who should be treated and when.
What is sleep apnoea?
Patients with obstructive sleep apnoea have recurrent episodes of partial or complete obstruction of the upper airway during sleep. These repeated interruptions in breathing result in intermittent oxygen desaturation and fragment, poor quality sleep.
Obstructive sleep apnoea is associated with hypertension, coronary artery disease, cardiac dysrhythmias, heart failure, stroke, insulin resistance and impaired glucose tolerance, depression, a reduced quality of life and an increased risk of road traffic accidents.
It is also linked to the impairment of multiple aspects of cognition and has been implicated in the early onset of cognitive decline by as much as a decade. Research suggests that OSA should also be recognised as a modifiable risk factor for Alzheimer’s disease.
The mechanism of cognitive impairment is thought to include neuroinflammation, oxidative stress, and increased sympathetic activity.
The primary treatment for OSA is continuous positive airways pressure, which provides a pneumatic splint to the upper airway.
How is OSA diagnosed?
Typical symptoms of obstructive sleep apnoea include daytime sleepiness or fatigue, snoring and witnessed apnoeas at night, and nocturia. The diagnosis is confirmed with a respiratory sleep study, which may be performed in hospital or in a patient’s home.
What is the treatment for OSA?
The primary treatment for obstructive sleep apnoea is continuous positive airways pressure (CPAP), which provides a pneumatic splint to the upper airway, preventing collapse and consequent intermittent hypoxia. Randomised controlled trials have shown that treatment of sleep apnoea with CPAP therapy can improve blood pressure which control in patients with systemic hypertension with the greatest benefits seen in patients with more severe sleep apnoea and in those patient with resistant hypertension.
Treating sleep apnoea with CPAP therapy has also been shown to improve cardiovascular outcomes and appears to improve neurocognitive architecture and function.
Weight loss significantly improves the severity of obstructive sleep apnoea, in obese patients. In patients with mild OSA and/or without marked obesity, or those with a recessed jaw, oral appliances (mandibular advancement devices) may be effective. In some patients with positional OSA, using a wedge to prevent supine positioning may be recommended.
Who should be referred for treatment?
Dr Alanna Hare recommends individuals experiencing daytime sleepiness should be screened for obstructive sleep apnoea.
There is no definitive guidance on who to treat with CPAP and when. CPAP therapy is recommended in patients with moderate or severe OSA. The role of CPAP in patients with mild obstructive sleep apnoea is less clear.
At Royal Brompton & Harefield Hospitals Specialist Care, we have a highly experienced team that has been diagnosing and treating adult patients with sleep disorders for more than 20 years. Our service for sleep-related problems is one of the largest in Europe. We have an international reputation for our work with patients experiencing sleep disorders.
Using the latest equipment, we can monitor progress remotely using advanced telemonitoring systems and CPAP titration devices to identify and resolve problems quickly, improve compliance and ensure optimum control of sleep apnoea.
How is OSA different to insomnia?
Insomnia is defined as daytime impairment or distress due to difficulty falling asleep, staying asleep or non-restorative sleep, even though the sufferer has had adequate opportunity to sleep. It affects around one in three people in the UK, particularly women and older people. To classify as insomnia, incidents must occur at least three times per week for at least one month.
Insufficient sleep has widespread impacts on physical health and mental wellbeing.
Cognitive behavioural therapy for insomnia (CBTi) is the recommended first line of treatment for insomnia lasting more than one month. CBTi incorporates behavioural management, including stimulus control therapy and sleep restriction, as well as cognitive strategies that aim to address the individual’s thoughts and beliefs about sleep. It also uses relaxation techniques, sometimes including mindfulness therapy, to address the hyperarousal that commonly contributes to insomnia.
Research suggests that CBTi is effective in reducing sleep onset latency (time taken to fall asleep), wake after sleep onset (time spent awake at night), sleep efficiency, and sleep quality, and that these effects endure over time.
How can we help?
At Royal Brompton & Harefield Hospitals Specialist Care, our sleep services include:
- consultations and treatment for private patients
- home sleep studies and home set-up on CPAP therapy
- access to latest CPAP devices and masks
- dedicated Centre for Sleep, for more detailed inpatient sleep studies
- respiratory sleep studies and full polysomnography
- cognitive behavioural therapy for insomnia, with personalised sleep programmes
- highly experienced support team
- latest telemonitoring equipment to improve treatment compliance and enable the rapid resolution of problems, without needing to attend clinic in person.
Consultant physician in sleep and respiratory medicine