Obstructive sleep apnoea (OSA)

OSA is a condition in which people breathe shallowly or stop breathing for short periods while sleeping. This can occur many times at night, leading to frequent arousals and disturbed sleep. These in turn can cause excessive daytime sleepiness, impaired concentration and hypoxaemia.

The consequences of untreated OSA include impaired daytime mental functioning, personality changes and social impairment. Importantly, it can have serious consequences on activities requiring alertness. Thus, there is up to a 12 fold increase in road traffic accidents (RTAs) in patients with OSA [1]. Sleepiness at the wheel may cause up to 20% of motorway accidents, with each fatal accident estimated to cost £1.25 million to society.

Furthermore, there is now strong and emerging evidence that OSA is an independent risk factor for coronary heart disease, hypertension and Stroke (estimated 2-4x increased risk). Moreover, there is also evidence that successful treatment of OSA can reduce diastolic blood pressure by up to 5 mmHg in trials. Over time, this might have a profound impact on cardiovascular and cerebrovascular risk, as part of a collective risk reduction strategy [2,3].

OSA is emerging as a significant public health problem, with a large and increasing demand for sleep service facilities due to the high prevalence and growing public awareness of its existence. Conservative estimates of the prevalence of OSA in middle aged men (30-65y) are between 0.3-2%, which are similar to

Type 1 diabetes mellitus [4]. The prevalence in women may be more than half that of men. The gold standard treatment is nocturnal continuous positive airway pressure (CPAP), delivered easily at home.

The diagnosis and treatment of sleep apnoea are now recognised as important national requirements endorsed by NICE and other healthcare organisations (e.g The British Thoracic Society). Thus capacity of services to accommodate an emerging healthcare requirement provides both a pressure and opportunity.

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