At-a-glance
- Classic triad: loud snoring + witnessed apnoeas + excessive daytime sleepiness (EDS).
- High-yield comorbidities: resistant hypertension, AF, obesity, type 2 diabetes, NAFLD, depression/anxiety, and refractory reflux.
- Don’t miss OHS: severe obesity + sleep-disordered breathing + morning headaches/excessive somnolence or signs of hypoventilation → urgent assessment.
- Safety: driving risk is real — explicitly ask about sleepiness at the wheel and advise appropriately.
Primary-care assessment (fast and structured)
- Symptoms: snoring, choking/gasping at night, witnessed apnoeas, unrefreshing sleep, EDS, morning headaches, nocturia, poor concentration, mood changes.
- Risk factors: BMI, neck circumference, male sex, alcohol/sedatives, nasal obstruction, family history.
- Screening tools (pragmatic): Epworth Sleepiness Scale and STOP-Bang are useful for structure (local pathways vary).
- Exam: BMI, BP, airway/nasal obstruction, tonsils, signs of heart failure/pulmonary hypertension if severe.
Initial management + referral (what usually helps quickest)
- Immediate advice: weight reduction support, avoid alcohol in the evening, avoid sedatives if possible, positional therapy if clearly positional, optimise nasal patency, sleep hygiene.
- Refer for diagnostic testing: home respiratory polygraphy or sleep study per local service.
- Likely treatments:
- CPAP commonly for moderate–severe OSAHS or significant symptoms.
- Mandibular advancement device may be appropriate for mild–moderate OSAHS where suitable.
- OHS often needs specialist respiratory input (and may require NIV rather than simple CPAP).
- Driving safety: if significant sleepiness, advise patient not to drive until assessed/treated; follow local DVLA advice and document clearly.
Frequently asked questions
Who should I suspect OSAHS in (high-yield triggers)?
Loud snoring + daytime sleepiness, resistant hypertension, AF, obesity, and witnessed apnoeas are the classic high-yield triggers. Ask directly about sleepiness at the wheel.
What is the key “don’t miss” diagnosis related to obesity?
Obesity hypoventilation syndrome (OHS) — particularly in severe obesity with marked somnolence, morning headaches, or cardiorespiratory complications; this needs prompt specialist assessment.
Does weight loss matter even if CPAP is planned?
Yes. Weight reduction improves OSAHS severity and cardiometabolic risk, and it complements device therapy rather than replacing it.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.