Obstructive Sleep Apnoea (OSA) is the most common sleep disordered breathing condition affecting stroke patients. It is characterized by the intermittent cessation or reduction of airflow during sleep due to complete or partial upper airway obstruction. The mainstay of treatment is Continuous Positive Airway Pressure (CPAP).
Not only are typical cardiovascular risk factors such as hypertension, hyperlipidaemia, diabetes, smoking, Atrial Fibrillation and obesity more prevalent in people with OSA, but OSA itself is an independent risk factor for stroke.
Core symptoms of OSA include excessive daytime sleepiness, snoring, and witnessed apnoea’s or hypopnea’s, gasping and choking sensations that rouse the patient (blockages or partial blockages of the airway leading to breathing cessations). Morning headaches are commonly reported.
OSA is common, affecting an estimated 1.5 million adults in the UK, and yet up to 85% are undiagnosed, therefore untreated.
The National Clinical Guideline for Stroke (2023) recommends:
- People with stroke or TIA should be screened for obstructive sleep apnoea with a valid clinical screening tool. People who screen positive who are suspected of having sleep apnoea should be referred for specialist respiratory/sleep medicine assessment.
There is also the NICE Guideline NG202, Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s.
A widely used assessment is STOP BANG which can be accessed on the tool’s official website.
The Sleep Apnoea Trust has in depth information including a directory of sleep clinics in the UK.