NICE guideline 202 covers investigation and management of obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s


NICE has published a new guideline on the investigation and management of obstructive sleep apnoea and related disorders.

NICE guideline (NG) 202, Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s, covers obstructive sleep apnoea/hypopnoea syndrome (OSAHS), obesity hypoventilation syndrome (OHS), and chronic obstructive pulmonary disease (COPD) with OSAHS (COPD–OSAHS overlap syndrome), providing advice on investigating and managing these related conditions.

This guideline aims to improve the recognition and management of OSAHS, OHS, and COPD–OSAHS overlap syndrome and ensure consistent care provision. The recommendations—which are intended for healthcare professionals, commissioners and providers, and people with OSAHS, OHS, or COPD–OSAHS overlap syndrome, and their families and carers—cover:

  • initial assessment, diagnostic tests, and treatment for OSAHS, OHS, and COPD–OSAHS overlap syndrome
  • prioritising people for rapid assessment by a sleep service
  • lifestyle advice
  • managing rhinitis in people with OSAHS, OHS, and COPD–OSAHS overlap syndrome
  • follow up, monitoring, and supporting treatment adherence.

Obstructive breathing disorders

OSAHS is a common, but 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.

OHS occurs when people who are obese are unable to breathe rapidly or deeply enough, resulting in low oxygen levels and high blood carbon dioxide levels. It is usually associated with OSAHS or nocturnal hypoventilation, and people with OHS often have cardiovascular complications and other comorbidities.

COPD–OSAHS overlap syndrome is the coexistence of OSAHS and COPD, which combined can cause a greater degree of oxygen deficiency, and increased morbidity, compared with either condition alone.

According to NICE, these conditions can profoundly impact people’s lives, causing excessive sleepiness or sleep disturbance that affects social activities, work performance, the ability to drive safely, and quality of life. Undiagnosed, these conditions are closely associated with serious health problems, including hypertension, diabetes, stroke, and heart disease, and can shorten life expectancy.

Prevalence in the UK

High numbers of the population are affected by these conditions, and they are often undiagnosed; it is estimated that 5% of adults in the UK have undiagnosed OSAHS. Both COPD and OSAHS are common conditions and are estimated to coexist, as overlap syndrome, in about 1% of the adult UK population. OHS is of particular concern because of rising obesity; it is already estimated to affect 0.3–0.4% of the UK population, with prevalence likely to grow.