This protocol addresses secondary polycythemia (erythrocytosis) in patients with obstructive sleep apnoea syndrome (OSA), where the raised haematocrit is driven by nocturnal oxygen desaturation.
Erythrocytosis associated with obstructive sleep apnoea is linked to recurrent nocturnal oxygen desaturation. Such patients warrant appropriate investigation before further management is undertaken.
The standard first-line intervention for OSA-associated erythrocytosis is long-term non-invasive continuous positive airway pressure (CPAP), which has been shown to reduce erythrocytosis in responding patients.
This next-line protocol applies when CPAP has not achieved a sufficient reduction in erythrocytosis — specifically, when the target fall in haematocrit has not been reached.
When CPAP has failed to adequately reduce erythrocytosis, a procedural intervention targeting haematocrit reduction becomes the next management step. The clinical goal is to bring the haematocrit to within a defined safe range. The complete evidence-based regimen — including the specific procedure, precise haematocrit targets, and decision criteria — is set out in the full protocol.
Erythrocytosis can be associated with advanced chronic obstructive pulmonary disease (COPD) and with obstructive sleep apnoea syndrome (OSA).
In the case of obstructive sleep apnoea, erythrocytosis is associated with nocturnal oxygen desaturation and such patients should be referred for appropriate investigation.
Patients who are symptomatic as a result of hyperviscosity or have a Hct >0.56 should be considered for venesection to reduce this to 0.50–0.52.
DOI: 10.1111/bjh.15647
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