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Top tips for GPs and primary care

Obstructive Sleep Apnoea (OSA) is common and treatable and yet is often undiagnosed. It is estimated that up to 80% of cases may be undiagnosed (Lee et al 2008).


Around 2% of middle-aged women and 4% of middle-aged men have the full syndrome, sometimes known as Obstructive Sleep Apnoea Syndrome (OSAS), consisting of night-time apnoeas combined with daytime symptoms (Young et al 1993).

The BLF uses the term Obstructive Sleep Apnoea to describe the condition including symptoms, as this is the term most commonly used.


Having undiagnosed OSA may increase the risk of hypertension, stroke and cardiac arrest, and OSA is associated with Type 2 diabetes.

Undiagnosed individuals are more at risk of having road traffic accidents – the DVLA estimates 20% of serious RTAs on major roads are caused by sleepy drivers. The IMPRESS service specification on OSA (2009) says individuals with uncontrolled OSAS have an increased rate of having RTAs of 3-7 times that of general driving population.

Core symptoms

Snoring when asleep
Stopping breathing or Struggling to breathe when asleep
Sleepiness (excessive) when awake
We call this The Triple S (based on Downey 2011)

Contributory factors and early recognition

OSA affects men, women and children. Patients who are most at risk include middle-aged overweight men, post-menopausal women and children with enlarged tonsils. Other physical attributes that increase risk include macroglossia and retrognathia and anything else that restricts upper airway patency.

The impact of OSA can be very severe for patients and their partners, and can severely impair quality of life.


NICE guidelines on the treatment of OSA (2008) state that Continuous Positive Airway Pressure (CPAP) is recommended for adults with moderate to severe symptomatic OSAS.

CPAP is cost-effective – the machine costs about £250 (should last at least 5 years) and the facial mask about £100 per year.

Other treatments include Mandibular Advancement Devices (for mild OSA) and lifestyle changes, including weight loss and sleep hygiene.

Oximetry evolution


CPAP is associated with more quality of life years and lower costs than non-treatment (NICE guidelines 2008). By comparison, the cost of one fatal RTA is estimated to be up to £1,500,000 (Mackay 2010).

“Treating some-one with sleep apnoea is so rewarding – it is a life-changer” - Andrew Meredith, Director of Sleep Disorder Service.
“Treatment saves marriages – I call it my happy clinic” - Professor Stephen Spiro, Professor of Respiratory Medicine.

BLF OSA Project

The BLF has launched a project to raise awareness of OSA, ensure that undiagnosed patients are referred for investigation, and lobby for standardized and improved services across England, Scotland, Wales and Northern Ireland.

In June 2011, we held Breathe Easy Week to launch the campaign, during which we held 158 events and achieved 65 pieces of media.
We have uploaded the Pictorial Epworth Sleepiness Scale (courtesy of Professor Martyn Partridge, Imperial College) onto our website, which was completed by over 6,000 people in the first two months.

The BLF calls on GPs to:

  1. Look for risk factors and signs of early OSA in your patients and give advice about lifestyle changes
  2. Use the Epworth Sleepiness Scale on the BLF website to screen patients who present with snoring and daytime sleepiness
  3. Take a case history, asking patients who present with snoring or sleepiness to give details of their day-time AND night-time symptoms
  4. Refer symptomatic patients to your local sleep clinic/service
  5. Ask the patient to contact the British Lung Foundation - - for more information

If you would like to become involved in the project, or require any further information, please contact

OSA project manager