Sleep apnoea: symptoms, causes, and treatments

Written by: Professor Suveer Singh
Published: | Updated: 12/02/2019
Edited by: Top Doctors®


Obstructive Sleep Apnoea (OSA) is a disorder characterised by pauses in breathing or periods of shallow breathing during sleep, which results in irregular breathing at night, sleep fragmentation and intermittent oxygen dips.

These can contribute to the manifestations such as excessive sleepiness during the day and other health implications. It usually manifests as snoring, excessive daytime sleepiness and witnessed pauses in breathing during sleep. It's prevalence is 4% of middle-aged men and 3% of women in the general population, but much higher in predisposed individuals.



Causes of sleep apnoea

The causes of sleep apnoea depend on a combination of risk factors such as; the predisposing structure of the upper airway, the brain’s threshold for awakening and what the degree of breathing response to an obstructed airway is.

Risk factors for sleep apnoea

  • Obesity - strongest risk factor.
  • Obese children - they have a higher prevalence and severity of OSA
  • Male gender.
  • Middle age - 55-59 in men, 60-64 in women.
  • Smoking.
  • Sedative drugs including sleeping tablets.
  • Excess alcohol consumption.
  • Family history.
  • Possible genetic tendency

Symptoms of sleep apnoea (usually a combination)

  • Loud snoring
  • Choking or gasping during sleep
  • Feeling short of breath on waking
  • Daytime fatigue
  • Other associations (cognitive decline, atrial fibrillation)

Investigation of Sleep Apnoea

An evaluation of the history - symptoms, sleep schedule and confounders, risk factors, associated conditions (i.e cardiovascular disease, diabetes mellitus) should be undertaken, ideally with the bed partner. A sleep specific questionnaire (to assess these elements and daytime function), and sleep diary are often helpful.

An overnight sleep study is then carried out, which involves measuring elements of SCOPER (i.e. sleep, cardiovascular, oxygen saturation, position, effort of respiration, respiratory flow) is undertaken to determine the presence and severity of the OSA. In selected cases, drug induced sleep endoscopy (DISE) can simulate sleep whilst observing the changes in calibre of the upper airway. This can help determine types of treatment likely to benefit the patient.

Treatment of sleep apnoea

After evaluation and diagnosis, if the patient is symptomatic or has a moderate or severe degree of sleep apnoea, they will benefit from treatment to maintain the patency of the upper airway during sleep.

The best established treatment is CPAP, associated with lifestyle changes. A few people may benefit from surgery to the upper airway to remove soft tissue (e.g. large tonsils).

Different treatment options include:

  1. Continuous Positive Airflow Pressure (CPAP) – an airflow generator provides a constant gentle stream of air through a tube and mask over the mouth and/or nose- this keeps the breathing passages open.
  2. Dental devices (mandibular advancement device) – to reposition the lower jaw and tongue.
  3. Surgery – (soft tissue or hard tissue) after other treatments have failed. Options may include tissue removal, jaw repositioning, implants or, in severe cases, creating a new air passageway (tracheostomy).

Snoring vs. sleep apnoea

Snoring does not cause sleep apnoea. However, it is an important symptom. Simple snoring does not usually lead to excessive daytime sleepiness (EDS). If snoring is accompanied by EDS, or witnessed pauses in breathing at night, then sleep disordered breathing, such as sleep apnoea may exist.

Is sleep apnoea curable?

A careful clinical, diagnostic and airway assessment, which identifies reversible risk factors (e.g. such as being overweight, large tonsils, blocked nose or sedatives) can help determine which types may be curable. Supporting and re-establishing the patency of the upper airway, whilst reversing risk factors can lead to cure in some cases.

By Professor Suveer Singh
Pulmonology & respiratory medicine

Professor Suveer Singh is a prominent, award-winning respiratory, sleep and critical care consultant based in central London, who specialises in bronchoscopy, respiratory infection and chronic cough alongside respiratory diseases, respiratory failure and chest pain. He privately practices at Cromwell Hospital, The Sloane Hospital and Shirley Oaks Hospital as well as London Bridge Hospital and Chelsea Outpatient Centre.  His NHS bases are Royal Brompton & Harefield, and the Chelsea and Westminster NHS Foundation Trusts, London.

Professor Singh, who is also professor of practice at Imperial College, London, is also an experienced specialist in sleep apnoea and other sleep disorders like insomnia, alongside acute respiratory infection including COVID-19 and post-ITU recovery. Furthermore, he also has consultant experience in cardiac and burns intensive care, and he is a member of the national, platinum-marked Royal Brompton ECMO-SARF service and lead of the SARF/ECMO follow-up clinic, most recently during the COVID-19 pandemic.

He has an BSc and MBBC from Guys & St. Thomas' Hospitals Medical School, and underwent further postgraduate training at Royal Brompton Hospital, King's College, Chelsea and Westminster and Hammersmith Hospitals in London. He undertook a PhD in the mechanism of microvascular dysfunction at the National Heart and Lung Institute, London.

Professor Singh, who is active researcher with interests in early diagnostic markers for ventilator pneumonia and Burns inhalation injury, bronchoscopy (EBUS and interventional) and respiratory infection alongside post intensive care syndrome and microcirculatory disorders, is a decorated clinical teacher. In 2013 he was awarded the Imperial NHS Teacher's award, while he has been the Distinguished Teacher nominee for the trust in 2014, 17 and 18.

He is also the lead for Year 5 Critical Care Medicine, examiner for the Royal College of Physicians MRCP and the European Society and Faculty of Intensive Care Medicine EDIC courses, as well as for international fellowship programmes. He has been tutor for the intensive care faculty FICM. He supervises PhD, MD and BSc fellows involved in critical care and respiratory medicine academic research and has held grants from the National Institute of Academic Anaesthesia and the Westminster Medical School Joint Research committee for MD studies. 

He is a fellow of the Higher Education Academy, frequently lectures nationally and internationally on Respiratory and sLDoee and examines internally and externally for MD and PhD awards.

Professor Singh is also chief and principal investigator for multicentre trials of early diagnostic markers in pulmonary infection and sepsis, weaning from ECMO and bronchoscopic sampling lung-volume reduction studies. He is also a respected academic who has published over 100 peer-reviewed articles, is the editor of the Oxford textbook Respiratory Critical Care and Respiratory Section editor and Editorial Board member of Medicine International. He is also an associate editor of Respiration, and reviewer for several international intensive care and respiratory journals.

Find out more about Professor Singh's work via his personal website, Respiratory Doctor.                       

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