Obstructive Sleep Apnoea

Julie Hilling Excerpts

Tuesday 2nd September 2014 Westminster Hall

[Julie Hilling (Bolton West) (Lab)]

I am very pleased to have secured this debate and to be—[Interruption.]

[Mr Dai Havard (in the Chair)]

Order. Could we have quiet, please, including in the Public Gallery?

[Julie Hilling]

Thank you, Mr Havard. I am very pleased to be serving under your chairmanship. You will not be surprised to learn that I first got interested in this subject from a road safety perspective. When a member of the Select Committee on Transport, I received an e-mail from the parents of a young woman who was killed by a lorry driver who fell asleep at the wheel, so I raised the issue on a number of occasions when we were doing different inquiries on things such as freight transportation and road safety. However, as soon as I started to talk about sleep apnoea, I discovered that it was far more common than I had thought—with a number of friends and acquaintances declaring that they had it—and that, in Bolton West, predicted rates of the condition are higher than the national average. I asked for the debate today to coincide with the launch of the British Lung Foundation’s obstructive sleep apnoea health economics report, because an estimated 1.5 million people have the condition in the UK, yet only 330,000 people are currently diagnosed and treated.

OSA affects people of all ages, including up to 4% of middle-aged men, 2% of middle-aged women and 20% of those aged over 70. Although not everyone with OSA is overweight, many are, and with an increasingly overweight and ageing population, it is anticipated that the rates of OSA will increase in the coming years.

What is obstructive sleep apnoea? It is a condition whereby the muscles in the throat relax, causing an obstruction in the airway during sleep, meaning that a person stops breathing. Some people stop breathing hundreds of times a night, and others have periods during which their breathing is restricted. Untreated OSA can have a profound impact on the quality of life of those affected and it has been proven to cause high blood pressure, as well as being associated with a host of other health conditions such as heart disease, heart failure, stroke and diabetes. The life of someone whose OSA is not treated can be dramatically shortened. Correct treatment has been shown to increase the probability of survival of OSA patients by 25%.

There is a strong link between OSA and an increased risk of road traffic accidents, with individuals who have uncontrolled OSA three to seven times more likely than the general driving population to have an accident on the road.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this issue to the House for hon. Members’ consideration. Many people will look on OSA as something that perhaps is not all that worrying, but from what the hon. Lady has said, it very much is. Does she feel that probably what we, the Minister and the devolved Administrations now need to do is to raise awareness of the condition through GP surgeries, leaflet drops and education?

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[Julie Hilling]

I thank the hon. Gentleman for that intervention. I absolutely agree that we need to do more and I will go on to talk about what the Government should be doing.

[Rosie Cooper (West Lancashire) (Lab)]

Before my hon. Friend gets to that, I congratulate her on securing the debate. Does she agree that with 80% of OSA cases not being diagnosed and the economic and social aspects of that being so dramatic—it costs so much to deal with strokes and heart attacks—we must do more to ensure that the National Institute for Health and Care Excellence regulations are implemented? The Government and the Department of Health cannot walk away from the health and social costs and the costs to the patient.

[Julie Hilling]

I thank my hon. Friend for that intervention. It feels as though she has looked at my speech, because I am going to cover in detail a number of the aspects that she has raised.

OSA can reduce a person’s ability to work and impair the quality of life of the person and their family. The story of Steve, one of my constituents in Bolton West, shows only too well what can happen when OSA is not diagnosed. When Steve was 36, he started to get lots of daytime sleepiness; indeed, he was sleeping all the time. He became very aggressive and went to his doctor, who treated him for depression. The first medication did nothing, and the second medication made him even more aggressive. He managed to maintain his job, but with great difficulty, often having to slope off for a sleep, and he was being threatened with dismissal. He did not have a relationship with his young daughter; between the ages of four and six years old, she had no relationship with her dad at all. He could not play with her or interact with her, except to snarl at her. Indeed, he did not have a relationship with his wife or anyone else at that time. The family went on holiday, but his wife said that she would never go away with him again because he slept the whole time. Eventually, he had to take sick leave from work, and for five months he never left his bed. He was so bad that his wife had to change the bedclothes around him. He had a constant headache and felt worthless as he was not contributing anything to society or his family. He could not eat properly and just could not function. He attempted suicide twice.

Steve was referred to a mental health consultant at Royal Bolton infirmary who immediately asked whether he had been tested for sleep apnoea and he was referred to Wythenshawe sleep clinic. There are three stages of sleep: a top layer, a lower layer and deep sleep. The sleep clinic discovered that every minute and 43 seconds, Steve went back to the top of the sleep cycle and was never getting into a deep sleep. He was given a continuous positive airway pressure—CPAP—machine. He went home, slept for 11 hours and was back at work the next day. Eight years later, he still uses the machine every night and has never looked back. It does have its downsides. He will not go abroad because he has a great fear of electricity cuts and he cannot sleep in the same room as his wife because of the noise of the machine, but he believes that that is a small price to pay for getting his life back. Steve feels like he suffered two years of torture. Let us not forget that sleep deprivation is listed as a proscribed method of torture. However, with a very low cost treatment, he can now function and live life to the full.

My friend’s sister, 52-year-old Jean, also had difficulty in getting her GP to take her issue seriously. She went to him because she was very tired all the time and kept falling asleep in work and on the bus home. She would go to bed and sleep all night, but wake up feeling just as drained and tired. After three visits, her GP started to take her problem seriously and, after running a number of tests with no result, referred her to Wigan infirmary. She got an appointment within three weeks, had her sleep monitored and then got a CPAP machine. It has not solved her problem completely, but it has much reduced the number of times she wakes up and she is able to enjoy life again.

[Yasmin Qureshi (Bolton South East) (Lab)]

I congratulate my hon. Friend on securing this Adjournment debate. On the point that she raises about how long it takes for people to be diagnosed, is it not correct that about 1.5 million people in this country probably suffer from this condition, but only about 330,000 people are ever diagnosed? Presumably, therefore, one thing that we need to do is to make medical practitioners aware that this condition is perhaps a lot more prevalent than we think it is.

[Julie Hilling]

I thank my hon. Friend for that intervention. She is right. We need to make both the public and medical practitioners aware. Also, we need to ensure that the services are in the right place. I will talk more about that in a moment, but first let me tell hon. Members about one more person. My office manager, Noelene, also surprised me by saying that she suffers from OSA; I never had any inkling that she did. She has an underactive thyroid and was extremely tired and forgetful. She would have no recollection of doing something or no memory of how she had got somewhere. She just blamed her thyroid, but her endocrinologist told her that her thyroid levels were fine and that she could not keep blaming everything on her thyroid. He referred her to his friend the sleep specialist. She collected a monitor that afternoon and less than four weeks later was given a CPAP machine. As the specialist said, if the mask works, it is OSA, and if not, it is something else and they will have to continue to investigate. She had problems with the mask initially and found it very uncomfortable but persevered. She could not get on with the full mask, because, as she said, a full mask and hot flushes are not a great combination, so she tried two other masks and now has a nose mask. Occasionally she does not use it, but immediately feels bad. She is now four years on from diagnosis and treatment.

I guess I am not surprised that I did not know that people had the condition, because snoring and falling asleep all over the place are still treated as a great joke, and the first reaction of most of us when we are told that we snore is immediately to deny it. The cost of undiagnosed sleep apnoea is enormous, however. Up to 80% of cases of OSA remain undiagnosed. Awareness of the condition is poor, and the risks associated with it are underestimated even by doctors. The British Lung Foundation led a three-year project to raise awareness of the condition and to campaign for the setting of quality standards for the treatment and care that OSA patients can expect. The OSA patients’ charter, published in 2012, was designed to do that, and it calls on the Government to prioritise OSA by increasing awareness, ensuring adequate data are collected for good service planning and investing more research into the condition.

Progress has been slow, however. The British Lung Foundation commissioned a report on the health economics of OSA, which will be published later this week, to demonstrate the economic and social arguments for greater focus on, and treatment of, the condition. The report finds that treating OSA can generate direct health benefits to OSA patients, and reduce costs incurred by the NHS, in comparison with not treating the condition. Currently, only 22% of OSA patients are treated across the UK, but increasing diagnosis and treatment rates to just 45% could yield an annual saving of £28 million to the NHS, as well as 20,000 quality-adjusted life years. That includes savings that result from reductions in road traffic accidents, heart attacks and strokes, as well as the positive impact on patients’ quality of life and improved survival rates over time. Other sources suggest that NHS expenditure on undiagnosed patients is estimated to be approximately twice that of people of the same age and the same gender. It is estimated that if everyone in the UK with moderate to severe OSA was treated, approximately 40,000 road traffic accidents could be prevented—accidents that not only affect sufferers of OSA, but cause injury and death to so many others.

The main treatment for OSA, continuous positive airway pressure, is very cost-effective. NICE usually values a treatment as cost-effective if it costs £20,000 to £30,000 per quality-adjusted life year gained, but the main treatment used for OSA costs the NHS only £5,000 per quality-adjusted life year gained. Because OSA is associated with other conditions such as heart disease, stroke and diabetes, some savings may also be made in the reduction of medication for those conditions. A Canadian study found that 38% of patients being treated for OSA reported a reduction in their intake of medicines to manage their other conditions.

What do we need to do? In July 2012, the Department of Health set up a working group on OSA to look at areas for improvement in care and services for the condition. However, the group was disbanded early in 2013 during the NHS restructure, and no one is responsible for taking forward the recommendations from the group’s work. The Department of Health should appoint a body to take forward those recommendations. In 2012, NICE was asked to produce a quality standard on sleep-disordered breathing. That has not been developed, and it should be taken forward as an immediate priority so that those with OSA know what to expect from their care.

Everyone who has symptoms of OSA should be diagnosed quickly and accurately, and they should receive the highest standard of care. That will help to reduce NHS costs and improve patients’ quality of life, and it could reduce the number of road traffic accidents that are caused by sleepy drivers. The level of risk of OSA varies across the UK depending on the prevalence of risk factors, and there is a mismatch between the geographical distribution of need and the regional distribution of services. Local commissioners must ensure sufficient availability of services in areas such as Bolton West that have a high estimated OSA prevalence. OSA screening and specialist referral should be introduced into the quality outcomes framework. Doing so would allow for more accurate data on the number of referrals being made from primary care and provide an immediate financial incentive for early intervention that would reduce costs and improve outcomes in the long term.

Finally, let me return to where I started on my journey of interest in OSA. Those who drive for a living, frequently on monotonous roads and motorways, are at risk of falling asleep at the wheel. Their lifestyle also puts them at increased risk of developing sleep apnoea. Those who fear that they have the disorder are often worried about seeking treatment, because they are concerned about losing their livelihood. I hope that the Minister will support the call of the sleep apnoea partnership group to expedite the treatment of vocational drivers so that they can be driving again within four weeks of referral.

[Rosie Cooper]

Before she reaches the end of her speech, will my hon. Friend emphasise that it makes absolutely no sense not to raise awareness of the condition, diagnose sufferers and provide treatment to improve the health of individuals, save the NHS money and reduce the number of sleep accidents? That is a no-brainer.

[Julie Hilling]

My hon. Friend has kindly done so for me. Clearly, OSA is a major issue, and one that is as serious in Bolton West as it is throughout the UK. The Minister assured me in February 2013 that a model care pathway and service specification to reduce variation in diagnosis and treatment would be developed, but we are still waiting. The time for talking is over. Research has been done and professional groups have informed the Government, so it is now time to take action. I will listen with great interest to the Minister’s response.