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Obstructive Sleep Apnoea: A Silent Epidemic

✍️Dr. Sanjeev Agarwal
📅June 5, 2025
⏱️7 min read

Obstructive Sleep Apnoea: A Silent Epidemic

Obstructive Sleep Apnoea (OSA) affects millions worldwide, yet remains significantly under-diagnosed. During my time establishing the OSA service at St Helens and Knowsley Teaching Hospitals NHS Trust, I witnessed the transformative impact of proper diagnosis and treatment.

What is Obstructive Sleep Apnoea?

OSA is characterized by repeated episodes of complete or partial upper airway obstruction during sleep, leading to:

  • Breathing pauses (apnoeas)
  • Reduced airflow (hypopnoeas)
  • Oxygen desaturation
  • Sleep fragmentation

    • The Warning Signs

    Common Symptoms

    Nighttime Symptoms:

  • Loud, chronic snoring
  • Witnessed breathing pauses
  • Gasping or choking during sleep
  • Restless sleep
  • Frequent nighttime urination

    • Daytime Symptoms:

  • Excessive daytime sleepiness
  • Morning headaches
  • Difficulty concentrating
  • Memory problems
  • Irritability and mood changes

    • Why OSA Matters: Health Implications

    Cardiovascular Risks

  • Hypertension
  • Heart attacks
  • Stroke
  • Arrhythmias
  • Heart failure

    • Metabolic Consequences

  • Type 2 diabetes
  • Metabolic syndrome
  • Weight gain
  • Insulin resistance

    • Quality of Life Impact

  • Reduced work productivity
  • Increased accident risk
  • Relationship strain
  • Mental health issues

    • Who's at Risk?

    Major Risk Factors

  • Obesity: The strongest risk factor
  • Age: More common in middle age and beyond
  • Male gender: 2-3 times more prevalent
  • Family history: Genetic predisposition
  • Anatomical factors: Large neck circumference, small jaw

    • Secondary Risk Factors

  • Smoking
  • Alcohol consumption
  • Sedative use
  • Nasal congestion
  • Certain medical conditions

    • Diagnosis: The Path to Treatment

    Clinical Assessment

  • Detailed History: Sleep patterns, symptoms, risk factors
  • Physical Examination: Airway anatomy, BMI, blood pressure
  • Screening Questionnaires: Epworth Sleepiness Scale

    • Sleep Studies

    Home Sleep Tests

  • Convenient and cost-effective
  • Suitable for most patients
  • Measures breathing, oxygen levels, heart rate

    • Polysomnography

  • Comprehensive hospital-based study
  • Gold standard for diagnosis
  • Monitors multiple parameters

    • Treatment Options

    1. Continuous Positive Airway Pressure (CPAP)

    The gold standard treatment:

  • Delivers pressurized air via mask
  • Keeps airway open during sleep
  • Highly effective when used consistently
  • Modern machines are quiet and comfortable

    • Benefits of CPAP:

  • Eliminates apnoeas
  • Improves sleep quality
  • Reduces cardiovascular risk
  • Enhances daytime alertness

    • 2. Lifestyle Modifications

    Essential for all patients:

  • Weight Loss: 10% reduction can significantly improve OSA
  • Sleep Position: Avoid supine (back) sleeping
  • Alcohol Avoidance: Especially before bedtime
  • Smoking Cessation: Reduces airway inflammation

    • 3. Oral Appliances

    For mild to moderate OSA:

  • Mandibular advancement devices
  • Position jaw forward
  • Keep airway open
  • Alternative for CPAP-intolerant patients

    • 4. Surgical Options

    Reserved for specific cases:

  • Uvulopalatopharyngoplasty (UPPP)
  • Nasal surgery
  • Jaw advancement surgery
  • Tongue base procedures

    • Establishing an OSA Service: Lessons Learned

    During my time in the NHS, I established a comprehensive OSA service from the ground up. Key elements included:

    1. Patient Pathway Development

  • Streamlined referral process
  • Rapid assessment clinic
  • Home sleep study program
  • CPAP initiation and support

    • 2. Multidisciplinary Approach

  • Respiratory physicians
  • ENT surgeons
  • Maxillofacial surgeons
  • Sleep physiologists
  • Specialist nurses

    • 3. Patient Education and Support

  • Pre-diagnosis counseling
  • CPAP training sessions
  • Ongoing troubleshooting
  • Peer support groups

    • Overcoming Treatment Barriers

    Common CPAP Challenges and Solutions

    Mask Discomfort

  • Try different mask styles
  • Ensure proper fitting
  • Use mask liners if needed

    • Claustrophobia

  • Gradual desensitization
  • Consider nasal masks
  • Relaxation techniques

    • Nasal Congestion

  • Use humidification
  • Address allergies
  • Consider nasal steroids

    • Partner Concerns

  • Education about benefits
  • Quieter modern machines
  • Separate sleeping arrangements initially

    • The Impact of Treatment: Patient Success Stories

    Over the years, I've seen remarkable transformations:

  • The executive who regained productivity and advanced in his career
  • The truck driver who could safely return to work
  • The couple whose relationship improved with better sleep
  • The diabetic patient whose blood sugar control stabilized

    • Public Health Perspective

    OSA is a significant public health issue:

  • Estimated 80% of cases remain undiagnosed
  • Economic burden from accidents and lost productivity
  • Preventable cardiovascular complications
  • Impact on healthcare resources

    • Raising Awareness

    We need:

  • Public education campaigns
  • Primary care physician training
  • Accessible diagnostic services
  • Affordable treatment options

    • Conclusion

    Obstructive Sleep Apnoea is not just about snoring—it's a serious medical condition with significant health implications. Early diagnosis and appropriate treatment can be life-changing, improving not just sleep but overall health and quality of life.

    If you or someone you know exhibits symptoms of OSA, don't ignore them. Consult a healthcare professional and take the first step toward better sleep and better health.

    Dr. Sanjeev Agarwal established the Obstructive Sleep Apnoea Service at St Helens and Knowsley Teaching Hospitals NHS Trust and has extensive experience in sleep medicine.

    About the Author

    Dr. Sanjeev Agarwal

    MBBS (Pat), MRCP (UK), CCST (UK), FRCP (London) - Founder & Director of Megastar Hospitals, Consultant Respiratory & General Physician, Honorary Clinical Lecturer at University of Liverpool with over 20 years of experience in respiratory medicine and healthcare innovation.

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