Pathophysiology

The pharyngeal muscles relax during sleep causing some degree of airway obstruction as the lumen of the airway reduces in size. Part of the airway can vibrate during inspiration causing snoring. In more serious cases complete closure of the airway causes apnoea, which means air entry stops completely. This is usually very short-lived and the patient wakes up quickly and takes another breath; these are known as arousals. Repeated apnoeas and arousals lead to very poor quality sleep and can have long-term ill effects such as hypertension, increased susceptibility to a stroke and cardiac disease.

About 4% of men and 2% of women have obstructive sleep apnoea (OSA). The main symptoms are snoring, excessive sleepiness during the day and reduced performance at work or, in the case of children, at school. OSA syndrome is thought to be an important factor in road traffic accidents, as severely affected patients can have episodes during the day when driving or operating machinery. In children it can contribute towards problems at school, behavioural issues as well as failure to thrive.

Diagnosis

A thorough history is crucial. Enquire about daytime sleepiness, snoring and the patient’s overall sleep pattern. Often, the patient themself will be unaware of the problem and the history will be obtained from a partner. In the case of a child, the parents will sometimes make a video showing the child’s sleep pattern, in particular showing the episode of apnoea preceded by the child struggling to breathe and then briefly stopping, before waking up.

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