DIAGNOSTICS ASSESSMENT PROGRAMME

Obstructive sleep apnoea hypopnoea syndrome (OSAHS) is a syndrome in which the upper airway becomes blocked repeatedly during sleep. It can intermittently reduce airflow (hypopnoea) or stop airflow completely (apnoea). Both apnoeas and hypopnoeas can occur in the same night. Symptoms of sleep apnoea include loud snoring, witnessed breathing pauses, gasping, choking, sleep disruption and unrefreshing sleep. Because of the sleep disturbance, symptoms may also occur during waking hours, including excessive sleepiness. Sleep disruption and excessive sleepiness can reduce quality of life, cognitive function and affect mental health. COPD–OSAHS overlap syndrome occurs in people who have both chronic obstructive pulmonary disease (COPD) and OSAHS.

In adults OSAHS is caused by various adulthood conditions such as overweight or obesity, hypertension, type 2 diabetes and cardiovascular disease. In children, the most common cause of OSAHS is adenotonsillar hypertrophy (enlarged tonsils or adenoids) which can partially obstruct the airway during sleep. Obesity and cranio-facial shape can also contribute to causing OSAHS. OSAHS can be associated with neurocognitive impairment, behavioural problems, faltering growth, hypertension, cardiac dysfunction and systemic inflammation in children.

Recommendations on detecting OSAHS and the care pathway can be found in NICE's guideline on obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s and the British Thoracic Society's guideline for diagnosing and monitoring paediatric sleep-disordered breathing. NICE recommends home respiratory polygraphy (RP) as the initial test for OSAHS in people over 16. If home RP is unavailable, home oximetry can be used but oximetry alone may be inaccurate for differentiating between OSAHS and other causes of hypoxaemia in people with heart failure or chronic lung conditions. Hospital RP or polysomnography (PSG) can also be used if additional monitoring is needed.

Home RP systems include multiple wired components which people need instruction to operate and can be uncomfortable to wear. Oximetry is a widely used alternative but is not considered a sensitive test for OSAHS diagnosis.

Expert clinical advice suggests that hospital-sleep testing capacity has reduced since the COVID‑19 pandemic, creating more reliance on home testing as the primary approach to sleep diagnostics. Some devices can be sent directly to the person by the manufacturer or NHS provider, which may improve access to home testing and reduce waiting times. This can potentially reduce time to diagnosis, leading to more timely treatment initiation and symptom improvement. Home-testing devices may also be less invasive than the ones currently used in the NHS, easier to put on and operate, and may also be more comfortable to wear.