Sleep Apnoea

1. Obstructive Sleep Apnoea (OSA) – is a respiratory illness and the most common type, where the upper airway is narrow or has become blocked.
2. Central Sleep Apnoea (CSA) is an uncommon neurological illness, where the brain does not signal the respiratory muscles to breath.
3. Mixed Sleep Apnoea is a combination of OSA and CSA.
4. Obesity Hypoventilation Syndrome.

Symptoms of sleep apnoea include:

1. Pauses in breathing or periods of shallow breathing.
2. Making gasping, snorting or choking noises.
3. Snoring loudly.
4. Waking up a lot.

During the day, you may also:

1. Feel very tired.
2. Find it hard to concentrate.
3. Experience mood swings.
4. Have a headache when you wake up.

In August 2021, NICE published its latest Guideline which “… covers the diagnosis and management of obstructive sleep apnoea/hypopnoea syndrome (OSAHS), obesity hypoventilation syndrome (OHS) and chronic obstructive pulmonary disease with OSAHS (COPD-OSAHS overlap syndrome) in people over 16. It aims to improve recognition, investigation and treatment of these related conditions”.

The Guideline will undoubtedly become a benchmark for diagnosing and treating patients with OSAHS, as well as other sleep disorders, and has been praised by various charities and working groups.

The Guideline encourages clinicians to prioritise patients for rapid assessment by a Sleep Service. It emphasises the need for the following people to be prioritised should they be suspected as suffering from OSAHS:

1. If they have a vocational driving job.
2. If they have a job for which vigilance is critical for safety.
3. It they have unstable cardiovascular disease.
4. If they are pregnant.
5. If they are undergoing preoperative assessment for major surgery.
6. If they have non-arteritic anterior ischaemic optic neuropathy.

This is a welcome move as there was limited evidence available on priority for assessment in a Sleep Service prior to the Guideline being published.

The Committee responsible for the implementation of the Guideline noted:

“In current practice, specific groups are not always prioritised for assessment, so there is likely to be a change in practice for some providers. There is increasing pressure on sleep services and offering higher priority to some groups may delay sleep studies for other people. Planning for and providing rapid-access sleep studies may help to reduce the pressure on services, with triage of referrals allowing people to be fast-tracked directly to a diagnostic study.”

The Guideline also provides advice on appropriate lifestyle changes for people with OSAHS, including:

• support and information on losing weight,
• stopping smoking,
• reducing alcohol intake and
• improving sleep hygiene.

The Guideline concludes with a summary of the advice that should be provided to patients who are diagnosed with such conditions. Patients should receive information on the underlying cause of their condition, what sleep studies involve, why treatment is important, what treatments are available, the impact of excessive sleepiness on safe driving and occupational risk, notifying the DVLA of their condition, lifestyle changes and other sources of patient support.

Several professional bodies have played important roles in the development of the Guideline, including the Sleep Apnoea Trust, a patient support charity which was founded in 1996 to help improve the lives of sleep apnoea patients, their partners and families.

The Trust aims to “… support patients through Education, Advocacy (lobbying), Raising Awareness Information and assisting Research and Development. It also raises awareness of the condition and acts as a lobbying group to represent the interest of sleep apnoea suffers”.

The Trust’s involvement has ensured that “the guidelines recommend making continuous positive airway pressure (CPAP) more easily available for patients with mild OSA, making custom-fit mandibular advancement splints (MADS) freely available on the NHS for those unable to tolerate CPAP (possibly up to 30% of UK cases) and ensuring that a more clinically assessed basis for CPAP/MADS treatment has been achieved”.

The Trust can be contacted via email.

The Sleep Charity also plays an important role in providing help and assistance to people who suffer from sleep apnoea, as well as other sleep disorders, and has been awarded the prestigious Queen’s Award for Voluntary Service (known as the ‘MBE for the voluntary sector). It is the highest accolade a voluntary group can receive in the UK.

The aims of the Charity are “… to provide access to high quality information and advice to deal with most sleep issues, and ensure everyone understands the value of a good night’s sleep. We also campaign for improvements to the support available as well as providing accredited training for professionals so they can offer sleep support to the people they work with”.

The Charity strives to help “… everyone to sleep better, regardless of their age, background or ability. We do this by working collaboratively, lobbying government, investing in research, building partnerships with organisations and offering a range of services including working directly with parents, offering workshops/webinars to corporate organisations and training professionals in the NHS and other health organisations.”

It is estimated that 40% of the population in the UK suffer with sleep related issues and many do not get the support that they need. By creating a greater awareness of these issues, the Charity hopes to improve peoples lives, both physically and mentally, as well as provide an environment for professional accredited training.

The Charity can be contacted via email.

At Wolferstans we also recognise the adverse effects that sleep related issues can have on individuals, especially in a clinical negligence setting, and have an experienced team of medical negligence lawyers who can provide help and support in securing compensation awards in respect of such injuries.

If you have suffered an injury of this nature, then please contact us on 01752 292201 or e-mail clientservices@wolferstans.com for a free consultation regarding the possibility of pursuing a clinical negligence claim.