TY - JOUR T1 - Obstructive sleep apnoea: is it moving into primary care? JF - British Journal of General Practice JO - Br J Gen Pract SP - e149 LP - e151 DO - 10.3399/bjgp16X683785 VL - 66 IS - 643 AU - John Stradling Y1 - 2016/02/01 UR - http://bjgp.org/content/66/643/e149.abstract N2 - Periods of obstructive sleep apnoea (OSA), first properly described in 1965,1 have been shown to occur in around 25% of males and 10% of females.2 But only about a fifth will need or benefit from treatment.OSA is due to excessive collapsing forces around the pharynx that overpower the decreased muscle tone during sleep. Snoring is an early marker of this collapse, and is either partial (causing hypopnoea) or complete (causing apnoea). To prevent asphyxia such events are terminated by a brief awakening after 20 to 40 seconds or so, restoring muscle tone and airflow, but of which the patient is rarely aware. A few such events during sleep are regarded as within the normal range, but there is a continuum of severity, with the most severe cases experiencing apnoeic events every minute across the whole night, with gross sleep fragmentation and recurrent hypoxic events. The dominant risk factor is upper-body obesity, mainly around the neck, although jaw shapes that reduce pharyngeal volume are important. In children, enlarged tonsils are the main risk factor and tonsillectomy is usually curative.Excessive daytime sleepiness is the main symptom of OSA, usually then called OSA syndrome (OSAS). This may be described as tiredness or fatigue, but closer questioning usually reveals it to be more sleepiness (though in women tiredness may be the main complaint). OSAS usually develops over several years, thus the patient may not be fully aware of just how symptomatic they are. Talking to a close relative can be useful, particularly regarding any sleepiness while driving. However, many people with OSA are not sleepy and do not need treatment.The main reason for any referral will be excessive sleepiness that interferes with quality of life, or impairs a vigilance-critical activity such as … ER -