Sleep Apnoea
Obstructive Sleep Apnoea
When to consider referral
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Those who would consider the continuous use of a CPAP mask AND:
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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
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Those with symptoms suggestive of OSA. These are (but not exclusively1):
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:
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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:
- Epworth Sleepiness Score. This has a poor negative predictive value to exclude OSA and referrals with low scores will not be cancelled. It does however identify high risk patients4.
- Documented discussion of patient's willingness to contemplate CPAP therapy. Information regarding this and other aspect of OSA is available at https://www.blf.org.uk/Page/Treatment-for-obstructive-sleep-apnoea-OSA
- recent BMI, recorded within the last 12 months
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
Date reviewed 28/02/2019
Next review due 28/02/2020
Sifter name Dr Alex Burns
Version No. 3.2