Introduction
OSA is the most common form of sleep-disordered breathing. The information provided in this resource of OSA managed in the primary care setting is intend for a range of health care practitioners including general practitioners, general practice nurses, pharmacists, dentists, dieticians, occupational therapists, physiotherapists.
This resource is intended for all primary care providers involved in the care of adult patients with obstructive sleep apnoea (OSA) - OSA in children and central sleep apnoea (CSA), which are primarily managed by specialists, are not discussed.
OSA is the most common form of sleep-disordered breathing. Ideally, OSA requires long-term, multidisciplinary management including general practitioners (GPs), other medical specialists when required, practice nurses, pharmacists, orthodontists, dentists, ear nose and throat (ENT) surgeons, psychologists, physiotherapists, dietitians and/or exercise physiologists. The team will vary depending on patient need.1
In OSA, apnoeas or temporary, brief cessation of breathing occurs during sleep repeatedly (See Pathophysiology), and may lead to daytime tiredness,2 sleepiness and/or decreased concentration (See Comorbidities & Complications). Risk factors include age, gender (e.g. OSA is most common among older males) and degree of overweight and obesity (See Presentation & Risk Factors). OSA can be diagnosed during a sleep study, i.e. polysomnography (PSG) (See Investigations & Referral). Sleep studies include a count of the number of apnoeas and hypopnoeas of >10 seconds per total number of hours sleep or where EEG sleep is not measured, per hours of recording across the sleep period. The apnoea hypopnoea index (AHI), measures the numbers of these events per hour of sleep and provides an indication of the severity of OSA.
Positional OSA occurs when the majority of hypopnoeas and apnoeas can be attributed to sleep position i.e. in a supine sleep position.
There are different treatment options for OSA available, including body weight reduction, continuous positive airway pressure (CPAP), mandibular advancement splint (MAS), positional therapy (PT), and surgery.
Table. Roles of the General Practitioner in the diagnosis and management of OSA
|
Models of care for OSA need to be tailored to specialist sleep service availability as well as local need and expertise. Recent randomised controlled trials have demonstrated that, with appropriate training and specialist support, patients with uncomplicated OSA (i.e. symptomatic, moderate-severe OSA, without significant respiratory, cardiac or psychiatric co-morbidities) can be managed in primary care by GPs and practice or community-based nurses just as well as in specialist sleep centres.3 There has also been significant interest in the use of limited-channel, home sleep study testing to improve diagnostic service provision, particularly where specialist sleep services may be more difficult to access.4
To avoid conflicts of interest, the Australasian Sleep Association and the Sleep Health Foundation advise that clinicians involved in the diagnosis of OSA and prescription of CPAP should not have a financial interest in the selling of CPAP machines.
AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset