No 26: Sleep apnoea

Up to 4% of people experience sleep apnoea, where they repeatedly stop breathing for 10 seconds or more while asleep. It is often related to heavy snoring. Doctors have linked the condition to stroke, heart disease and other problems. But a review of the evidence shows that sleep apnoea is not a major health hazard and raises question marks over common treatments.

What is it?

Understanding of sleep apnoea is still in its infancy. The condition, identified in the last 15 years, is caused by repeated collapsing of the upper airways, often due to excess fat in the neck area, which stops breathing for short periods. This may cause loud snoring. It typically affects middle-aged, overweight men but the problem increases with age. Many sufferers do not realise they have the condition. Often it is partners who send them to a doctor. Daytime sleepiness - due to poor rest at night - is a common symptom, but also experienced by nearly half of the population.

Is it bad for the health?

When sleep apnoea was recognised, doctors warned that it caused early death from heart problems, stroke and high blood pressure. This fuelled an industry in treating the syndrome. But extensive analysis of the research shows there is no conclusive evidence of any link with premature death. It found most studies had failed to take account of other health risks, such as obesity. There is stronger evidence that sleep apnoea causes daytime sleepiness which reduces concentration, and a fairly strong but inconclusive link with driving accidents. Three studies found sufferers made significantly more errors in computer-simulated driving.

Treatment

The commonest treatment is a bedside ventilator which pumps air into the nose to keep airways open during sleep. Called continuous positive airways pressure (CPAP), it is noisy, uncomfortable and often disliked. CPAP is most effective for severe sufferers. Dental mouthpieces also provide significant improvement and are preferred by patients. The benefits of surgery to remove part of the throat are not proven. Overall, losing weight could be the best option as this cures the condition.

What works? is based on reviews of the most up-to-date and reliable evidence available. It is written in collaboration with the NHS Centre for Reviews and Dissemination at York University (01904 433 634) and is verified by experts.