Obstructive Sleep Apnoea (OSA)
Repeated upper-airway collapse during sleep causing fragmented sleep and daytime sleepiness.
Overview
OSA affects roughly 1 in 5 adults to some degree. Untreated moderate-to-severe OSA increases the risk of road traffic accidents, hypertension, atrial fibrillation, stroke and cardiovascular death. CPAP is highly effective.
Symptoms
- • Loud snoring with witnessed pauses in breathing
- • Gasping or choking arousals
- • Excessive daytime sleepiness (Epworth ≥11)
- • Morning headache, dry mouth
- • Poor concentration, low mood, reduced libido
Risk factors
- • Male sex, post-menopausal female
- • Age 40–70
- • Obesity
- • Hypothyroidism, acromegaly
- • Family history
Causes
- • Pharyngeal muscle relaxation during sleep
- • Obesity, neck circumference >43 cm (men) / >40 cm (women)
- • Craniofacial features: retrognathia, large tonsils, narrow palate
- • Alcohol and sedative use at night
🚨 Red flags — seek urgent care
- • Sleepiness while driving — stop driving and inform DVLA
- • Resistant hypertension or new atrial fibrillation
- • Pulmonary hypertension or right heart failure
When to seek care
- • Loud snoring with witnessed apnoeas
- • Daytime sleepiness affecting work or driving
- • STOP-BANG score ≥3
Diagnosis
- • Validated screening (Epworth, STOP-BANG)
- • Home respiratory polygraphy or in-lab polysomnography
- • Apnoea–Hypopnoea Index (AHI): 5–14 mild, 15–29 moderate, ≥30 severe
- • Assess for cardiometabolic comorbidities
Treatment
- • Weight loss (often curative in mild OSA)
- • Positional therapy and avoiding alcohol/sedatives at night
- • CPAP — first-line for moderate-to-severe OSA
- • Mandibular advancement device for mild–moderate disease or CPAP intolerance
- • ENT surgery in selected anatomical cases; hypoglossal nerve stimulation in specialist centres
Prevention
- • Maintain healthy weight
- • Avoid alcohol within 4 hours of bedtime
- • Treat nasal obstruction
Complications
- • Hypertension and atrial fibrillation
- • Stroke, myocardial infarction
- • Type 2 diabetes worsening
- • Motor vehicle collisions
Prognosis
CPAP adherence (>4 hours/night) normalises daytime sleepiness for most patients and improves BP and quality of life.
Education & self-care
OSA is common, treatable and serious if ignored. CPAP feels intrusive at first but most users report dramatic improvement within weeks.
Frequently asked questions
Is snoring always OSA?
No — snoring alone is common. OSA requires witnessed pauses, sleepiness or abnormal AHI on testing.
Do I have to use CPAP forever?
Yes, while the underlying anatomy persists. Significant weight loss can reduce or eliminate the need.
Is CPAP the only treatment?
CPAP is the gold standard for moderate-to-severe OSA. Mandibular advancement devices, weight loss, positional therapy and selected surgery are options for milder disease or CPAP intolerance.
Will treating OSA help my blood pressure?
Yes — effective CPAP typically lowers blood pressure by a small but clinically meaningful amount, and may reduce the need for additional antihypertensives in resistant hypertension.
Can I drive if I have OSA?
If excessive daytime sleepiness affects driving, you must inform the DVLA in the UK. Driving can resume once symptoms are controlled with treatment, confirmed by your clinician.