Snore Centre eNewsletter September 2021

NICE published first ever guidance for sleep apnoea

The National Institute for Health and Care Excellence (NICE) has published its first ever clinical guidelines for 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.

Developed by the National Guideline Centre (NGC), hosted by the Royal College of Physicians (RCP), this is the first NICE clinical guideline on this topic.

The guideline aims to improve recognition and management of OSAHS, OHS and COPD–OSAHS overlap syndrome, and ensure consistent provision of care. It gives advice to healthcare professionals on when and how to investigate, and how to manage each of these conditions. It also gives guidance on supporting people to adhere to treatment and providing follow-up.

The guideline includes recommendations on:

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

The recommendations are also presented in four algorithms: one for the initial assessment and one for each condition on the investigations and treatments recommended.

The full guidelines can be found on NICE’s website.

New study shows CPAP machines help COVID patients avoid ventilator

Giving hospitalised Covid patients sleep apnoea mask cuts their risk of falling even more ill, a study reported in The Mail Online has suggested. Researchers at Warwick University and Queen's University Belfast found continuous positive airway pressure (CPAP) machines stop some seriously ill patients needing to be hooked up to a ventilator. 

The therapy — which can cost up to £720 — works by pumping air into the lungs to stop the upper airways from collapsing. It was originally designed for sleep apnoea sufferers, helping them breathe during the night and stopping them from snoring. But the NHS says its is helpful in other situations, with the masks used to treat Covid patients since the pandemic began.

The academics sought to compare how CPAP compared to standard oxygen therapy, which delivers oxygen via a loose fitting mask. The trial of more than 1,200 patient across 48 UK hospitals also looked at HFNO (high pressure oxygen delivered up the nose). Every one in 12 patients who were moved on from standard oxygen therapy to CPAP were prevented from requiring mechanical ventilation, data suggested.

Researchers said their findings, which have not yet peer-reviewed, can help reduce pressure on intensive care units. The results should give patients and their families confidence the treatment can be used in place of standard oxygen therapy, the team said. Professor Gavin Perkins, from Warwick, said:

'By giving patients the most effective treatment to begin with, we can help prevent resource shortages in our NHS and make sure the right type of ventilation is available to patients when it is required. This is the first large trial of different types of ventilation in Covid. While it is encouraging that these results can help reduce the number of people who require invasive ventilation, it is important to stress that, where it is needed, invasive ventilation can be lifesaving. What this trial does, for the first time, is provide an evidence base that can give patients, their families and clinicians, the confidence to step from controlled oxygen therapy to CPAP. One in 12 people [who have] that therapy will escape the need for invasive ventilation.'

Data also suggested the routine use of HFNO should be reconsidered. Results showed the therapy did not improve outcomes for Covid patients compared, with conventional oxygen therapy. Professor Perkins said: 'The routine use of HFNO, which can consume large amounts of oxygen, should be reconsidered as it did not improve outcomes.'

The Respiratory Strategies in Covid-19, CPAP, High-flow, and Standard Care (Recovery-RS) trial is the world's largest non-invasive respiratory support trial for Covid. All three methods studied are commonly used to treat Covid patients suffering acute respiratory failure. But it was not known which, if any, resulted in a better outcome.

Between April 2020 and May 2021, 1,272 Covid patients admitted to hospital with acute respiratory failure, aged over the age of 18, were recruited to the study. They were randomly allocated to receive one of the three respiratory support interventions as part of their hospital care.

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Check out the redesigned Sleeping Disorders Centre website 

Sleeping Disorders Centre moves to online clinics

Since the outbreak of COVID-19 attending hospitals and clinics in person has been difficult and potentially involves the risk of catching or spreading coronavirus. Therefore, the Sleeping Disorders Centre's services are now available  online for both NHS and private patients.



We are able to deliver the same high quality service either via telephone or online, organising all aspects of care remotely: including sleep studies, diagnosis, CPAP fitting, delivery, maintenance and long-term care.

This means that people suffering from obstructive sleep apnoea and other sleep-related and ENT conditions are still able to access first class care from Mr. Oko, Professor Dhillon and the rest of our clinical team. Our mission to raise awareness of the suffering caused by sleep apnoea, and enable those affected to live normal lives through fast diagnosis and effective treatment, is still continuing depite the challenges of the pandemic.

The Sleeping Disorders Centre's private clinic has moved from Harley Street to The London Digestive Centre, in partnership with HCA Healthcare. All appointments with Mr. Oko are taking place by phone or online, and in person appointments continuing with Prof. Dhillon.



Contact details

Private patients
The London Digestive Centre
41 Welbeck Street
London
Telephone: 020 3797 7248
Email: david.odimayo@sleepthebestmedicine.com