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Sleep Apnoea

Obstructive Sleep Apnoea

 

When to consider referral

  • Those who would consider the continuous use of a CPAP mask AND:
    • Those with symptoms suggestive of OSA. These are (but not exclusively1):
      • Sleepiness in the daytime, including falling asleep in inappropriate situations
      • Unrefreshing sleep
      • Waking up gasping
    • An Epworth Sleepiness Score of >10

Do not refer:

  • Those who present with snoring alone (especially when initiated by patient's bed partner2). Please see Snoring Guidelines
  • Those who do not have daytime somnolence (eg are only  "tired" or "fatigued" without  propensity to fall asleep in the day)
  • Those with symptoms limited to disturbed sleeping patterns

 

Primary care management prior to referral:

  • Lifestyle advice on:
    • Weight loss
    • Exercise (reduces OSA symptoms alone in absence of wt loss3)
    • Reducing alcohol
    • Smoking cessation
  • Advise good sleep hygiene, including having enough time for sleep.
  • Advise to sleep on their side
  • Medication review: consider stopping drugs with sedative effects
  • Discuss the continuous use of a CPAP mask. This is the only treatment of established OSA, and referral without discussing risks a wasted appointment

 

Information required with referral:

 

Clinic options:

  • All referrals will be seen and assessed with Polysomnography

 

Red flags (for urgent referral)

  • Those who are sleepy whilst driving or working with machinery
  • Those employed in a hazardous occupation (e.g. pilots, bus or lorry drivers)
  • Those with objective signs or a confirmed diagnosis of respiratory failure (such as COPD) or heart failure
  • An Epworth score >18

References:

1.       Greenstone Michael, Hack Melissa. Obstructive sleep apnoea BMJ 2014; 348 :g3745

2.       Hoy CJ, Vennelle M, Kingshott RN, Engleman HM, Douglas NJ. Can intensive support improve continuous positive airway pressure use in patients with the sleep apnea/hypopnea syndrome? Am J Respir Crit Care Med 1999;159:1096–1100.

3.       Iftikhar, I., Kline, C. and Youngstedt, S. (2014) Effects of exercise training on sleep apnea: a meta-analysis. Lung192(1),175-184. Exercise recommendation

4.       Myers KA, Mrkobrada M, Simel DL. Does This Patient Have Obstructive Sleep Apnea? The Rational Clinical Examination Systematic Review. JAMA. 2013;310(7):731-741. doi:10.1001/jama.2013.276185. Not snoring alone