Obstructive sleep apnoea (OSA) is characterised by:

• excessive daytime sleepiness, snoring and fatigue
• witnessed breathing pauses (apnoeas), gasping or choking while sleeping
• unrefreshing sleep, impaired concentration.

The National Institute for Health and Care Excellence clinical knowledge summaries give further information as to wider diagnostic indicators, risk factors, complications and assessment process. Screening questionnaires (such as STOP-Bang and Epworth sleepiness scale) are also available.

People with a learning disability and autistic people

Evidence suggests that obstructive sleep apnoea (OSA) is more common in people with a learning disability, particularly amongst people with Down’s Syndrome, as well as in autistic people who may also find it harder to express that they have a sleep problem. OSA can also exacerbate gastric reflux which is common in patients with Down’s syndrome.

Treating obstructive sleep apnoea (OSA)

Continuous positive airway pressure (CPAP) is the usual treatment for reducing the number of apnoea and hypopnoea, therefore eliminating associated side effects, reducing incidence of health complications and improving quality of life. CPAP is a long-term treatment and should be used every night for as long as the person is asleep to work effectively.

CPAP can be a challenge for some people due to the nature of the treatment and can have a high abandonment rate. This may disproportionately impact patients with a learning disability or autistic people, due to additional sensory difficulties.

People with a learning disability and autistic people with OSA may be at increased risk if they or their carers do not understand the importance of consistently using a CPAP machine; they also already face a higher risk of health inequality and premature mortality than the general population. Several recent safeguarding investigations have identified CPAP machines not being used as prescribed as a factor in the deaths of people with a learning disability.             

With adequate guidance, CPAP is shown to be feasible and effective in people with a learning disability supporting better outcomes such as reduced blood pressure, arrhythmias, stroke, cardiovascular events and left ventricular heart failure.

Any difficulties using CPAP ideally need to be resolved quickly.  Although it can be considered at any point of contact, a particular opportunity in primary care to discuss this is during the annual health check. The individual can be signposted to contact the sleep clinic if they have any problems using their CPAP machine, so that these issues can be addressed. A remote monitoring CPAP machine for example, may be beneficial by improving compliance and could be considered for this patient group.

For further information, please see our healthcare professionals guide to obstructive sleep apnoea for people with a learning disability and autistic people, or visit the National Institute for Health and Care Excellence for guidance relating to management of OSA.