When assessing a patient for obstructive sleep apnoea/hypopnoea syndrome (OSAHS) in individuals over 16 years, key clinical features from a sleep history and the presence of certain associated conditions should be considered NICE NG202.
- Key Clinical Features from Sleep History
Suspect OSAHS if a patient presents with two or more of the following features from their sleep history NICE NG202:
- Snoring NICE NG202
- Witnessed apnoeas NICE NG202
- Unrefreshing sleep NICE NG202
- Waking headaches NICE NG202
- Unexplained excessive sleepiness, tiredness, or fatigue NICE NG202
- Nocturia (waking from sleep to urinate) NICE NG202
- Choking during sleep NICE NG202
- Sleep fragmentation or insomnia NICE NG202
- Cognitive dysfunction or memory impairment NICE NG202
- Conditions with Higher Prevalence of OSAHS
Be aware that OSAHS has a higher prevalence in people with any of the following conditions NICE NG202:
- Obesity or overweight (including in pregnancy) NICE NG202
- Treatment-resistant hypertension NICE NG202
- Type 2 diabetes NICE NG202
- Cardiac arrhythmia, particularly atrial fibrillation NICE NG202
- Stroke or transient ischaemic attack NICE NG202
- Chronic heart failure NICE NG202
- Moderate or severe asthma NICE NG202
- Polycystic ovary syndrome NICE NG202
- Down's syndrome NICE NG202
- Non-arteritic anterior ischaemic optic neuropathy (sudden loss of vision in one eye due to decreased blood flow to the optic nerve) NICE NG202
- Hypothyroidism NICE NG202
- Acromegaly NICE NG202
- Assessment Scales
For preliminary assessment of sleepiness, the Epworth Sleepiness Scale should be used NICE NG202. Additionally, consider using the STOP-Bang Questionnaire NICE NG202. It is important not to rely solely on the Epworth Sleepiness Scale to determine the need for referral, as not all individuals with OSAHS experience excessive sleepiness NICE NG202.