Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s

Context

This guideline covers obstructive sleep apnoea/hypopnoea syndrome (OSAHS), obesity hypoventilation syndrome (OHS), and chronic obstructive pulmonary disease (COPD) with OSAHS overlap syndrome, providing advice on investigating and managing these related conditions.

OSAHS is a common, but frequently unrecognised cause of serious disability that has important health and social consequences. It is characterised by recurrent episodes of complete or partial upper airway obstruction during sleep resulting in dips in oxygen level, autonomic dysfunction and sleep fragmentation. There are a number of clinical and physiological variants (phenotypes) of the condition, which may influence treatment response.

OHS occurs when people who are obese are unable to breathe rapidly or deeply enough, resulting in low oxygen levels and high blood carbon dioxide levels. It is usually associated with OSAHS or nocturnal hypoventilation, and people with OHS often have cardiovascular complications and other comorbidities.

COPD–OSAHS overlap syndrome is the coexistence of OSAHS and COPD, which combined can cause a greater degree of oxygen deficiency, and increased morbidity, compared with either condition alone.

These conditions can have a profound impact on people's lives, causing excessive sleepiness or sleep disturbance that affects social activities, work performance, the ability to drive safely and quality of life. Undiagnosed, these conditions are closely associated with serious health problems, including hypertension, diabetes, stroke and heart disease, and can shorten life expectancy.

High numbers of the population are affected by these conditions, and they are often undiagnosed; it is estimated that 5% of adults in the UK have undiagnosed OSAHS. Both COPD and OSAHS are common conditions and are estimated to coexist, as overlap syndrome, in about 1% of the adult UK population. OHS is of particular concern because of rising obesity; it is already estimated to affect 0.3% to 0.4% of the UK population, with prevalence likely to grow.

The availability of services for investigation and management is variable. Failure to treat these conditions can result in an increased use of services and may leave people with a reduced quality of life. Highly effective treatment, in the form of continuous positive airway pressure (CPAP), is available. But approaches to CPAP therapy differ and there is a lack of guidance on when other forms of treatment, such as non-invasive ventilation, oral devices, lifestyle changes and surgery are effective. Adherence to therapy is known to be low, so advice on interventions to help with adherence is also a priority for this guideline.

This guideline is needed to improve recognition and management of OSAHS, OHS and COPD–OSAHS overlap syndrome, and ensure consistent provision of care. It gives advice to healthcare professionals on when and how to investigate, and how to manage each of these conditions. It also gives guidance on supporting people to adhere to treatment and providing follow-up.