NICE (National Institute for Health & Care Excellence) and Sleep Apnoea

NICE is the UK body that evaluates the quality and cost effectiveness of clinical treatments prior to adoption by the NHS.

August 2021 – New NICE Guideline NG202, Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s

This guideline covers the diagnosis and management of obstructive sleep apnoea/hypopnoea syndrome (OSAHS), obesity hypoventilation syndrome (OHS) and chronic obstructive pulmonary disease with OSAHS (COPD–OSAHS overlap syndrome) in people over 16. It aims to improve recognition, investigation and treatment of these related conditions.

Recommendations
This guideline includes recommendations on:

• OSAHS initial assessment, diagnosis and management
• OHS initial assessment, diagnosis and management
• COPD–OSAHS overlap syndrome initial assessment, diagnosis and management
• Providing information for people with OSAHS, OHS or COPD–OSAHS overlap syndrome

See visual summaries on the recommendations for:

• OSAHS, OHS and OSAHS-COPD overlap syndrome
• OSAHS: investigations and treatment
• OHS: investigations and treatment
• COPD-OSAHS overlap syndrome: investigations and treatment

To view the new guideline please click on this link: https://www.nice.org.uk/guidance/ng202

Sleep disordered breathing is a generic term that includes obstructive sleep apnoea/hypopnoea syndrome, central sleep apnoea and nocturnal hypoventilation. There is an overlap between these conditions, but the underlying aetiology and pathogenesis is diverse, and prevalence,  investigation and management differ. Obstructive sleep apnoea/hypopnoea syndrome is the most common form of sleep disordered breathing and therefore it is the focus of the guideline.  Although obstructive sleep apnoea/hypopnoea syndrome is common, it is a  frequently unrecognised cause of serious disability that has important health and social consequences. It is characterised by recurrent episodes of complete or partial upper airway obstruction during sleep resulting in dips in oxygen level, autonomic dysfunction and sleep fragmentation. The consequent daytime sleepiness can be profound, affecting social activities, work performance, the ability to drive safely and quality of life.

Key facts and figures:

• It is estimated that 5% of adults in the UK have undiagnosed obstructive sleep apnoea/ hypopnoea syndrome – that is, over 2.5 million people.
• Although closely associated with obesity, one-quarter to one-third of people 30 affected are not obese.
• High-risk groups include those with cardiac disease, refractory hypertension, arrhythmias, cerebrovascular disease and type 2 diabetes.
• Obstructive sleep apnoea/hypopnoea syndrome can worsen these conditions.

Current practice

• Clinical assessment and questionnaires are sometimes used to select patients for investigation.
• Diagnosis is made by monitoring breathing during sleep – a sleep study.
• A range of sleep studies of varying complexity can be performed, some as an inpatient, or at home, depending on local arrangements and patient preference.
• The availability of appropriate services for investigation and management is patchy.
• Failure to treat the condition can result in increased healthcare utilisation.
• Recognition and optimal investigation and management need experienced clinical teams, usually working in respiratory medicine departments in secondary care.
• Highly effective treatment, in the form of continuous positive airway pressure (CPAP), is available, however approaches to personalising CPAP therapy differ.
• Other forms of treatment, or adjuncts to treatment, include intraoral mandibular advancement devices and advice on weight reduction if appropriate.
• Guidance is required as to when, and in whom, these forms of treatment may be an effective option.
• In people who are severely obese, bariatric surgery may improve symptoms of obstructive sleep apnoea/hypopnoea syndrome in addition to its other recognised benefits.
• Clinics, telemonitoring and data downloads from CPAP devices may help with adherence to therapy, but their effectiveness is not clear.
• This guideline aims to provide evidence-based recommendations for the investigation and management of obstructive sleep apnoea/hypopnoea syndrome in adults and young people (16 and older).

All document on the project that are for public viewing can be found on: https://www.nice.org.uk/guidance/indevelopment/gid-ng10098/documents

“NICE TA139, which as been in place since Mar 2008 has also been modified to allow for changes contained in NG202”
https://www.nice.org.uk/Guidance/TA139