Open Access
Feature Article

Obstructive sleep apnoea – navigating the system

Open Access
Feature Article

Obstructive sleep apnoea – navigating the system

CLAIRE M. ELLENDER, CERYS JONES, CRAIG HUKINS

Figures

© chameleonsey/ istockphoto.com Models used for illustrative purposes only
© chameleonsey/ istockphoto.com Models used for illustrative purposes only
Dr Ellender is a Respiratory and Sleep Physician at the Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane; and Senior Lecturer at the Faculty of Medicine, Princess Alexandra Southside Clinical Unit, University of Queensland, Brisbane. Dr Jones is a General Practitioner at Eastbound Medical Clinic, Bentleigh East, Melbourne, Vic. Dr Hukins is a Respiratory and Sleep Physician at the Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane; and Associate Professor at the Faculty of Medicine, Princess Alexandra Southside Clinical Unit, University of Queensland, Brisbane, Qld.

Abstract

Obstructive sleep apnoea (OSA) is becoming increasingly prevalent in our communities. GPs are well placed to recognise, investigate and manage many patients with uncomplicated OSA. Navigating the system to help patients access diagnostic sleep studies and appropriate treatment can be difficult. This article aims to demystify the system and help facilitate timely treatment.

Key Points

  • Obstructive sleep apnoea (OSA) is a common chronic disease and is increasing in prevalence.
  • A focused history is important to evaluate for the likelihood of OSA and to identify patients at risk of the consequences of untreated OSA.
  • A sleep study is needed to confirm the diagnosis and evaluate the severity of disease.
  • Continuous positive airway pressure (CPAP) therapy is the gold standard for many symptomatic patients with moderate to severe OSA.
  • Other treatment options are available for less severe disease or for those with difficulties in using CPAP.

All GPs will have seen patients dragged in by their bed partner with fatigue, loud snoring and excessive daytime sleepiness and suspected obstructive sleep apnoea (OSA) to be the likely diagnosis. OSA is a sleep disorder characterised by obstruction or collapse of the upper airway during sleep, resulting in oxygen desaturation and sleep fragmentation. It is the most common cause of excessive daytime sleepiness, unrefreshing sleep and snoring, and a cause of reduced workplace productivity. 

OSA is increasing in prevalence in Australia due to increasing obesity.1 It is a very treatable disease, often with continuous positive airway pressure (CPAP) therapy. However, navigating the system from symptoms to treatment requires a customised approach to match the patient with the correct testing modality and treatment. 

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With the increase in prevalence of OSA, management of OSA is increasingly becoming the domain of primary care. This article aims to demystify the system and help facilitate timely treatment, to help our patients feel less sleepy, more productive and have lower motor vehicle accident risk. Patients without significant comorbidities and a history consistent with OSA are suitable for GP-referred sleep studies and can be initiated on therapy in the community with follow up at the primary care level. This article will cover the specific comorbidities and history to look for to stratify patients into those who can be managed in primary care and those who require in-laboratory studies and sleep physician review.  

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Consequences of untreated OSA

The pathophysiology of OSA is shown in the Figure. Untreated severe OSA is associated with a fourfold increase in all-cause mortality and increased cardiovascular disease, such as ischaemic stroke, myocardial infarction, hypertension and arrhythmia.

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Severe OSA is also associated with a sevenfold increased risk for multiple vehicle crashes in a five-year period, independent of age and driving time.3,4 It is essential to ask about driving safety when taking a sleep history – falling asleep at the traffic lights, near misses or inattention due to sleepiness and  previous sleepiness-related accidents are predictors of motor-vehicle accident risk.