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Sleep apnoea

Emergency referrals

Information that may lead to more urgent categorisation

  • History of near miss or recent MVA
  • Occupational reasons for rapid assessment e.g. Taxi, HGV driver, heavy machinery operator

Other important information for referring practitioners

For diagnosis or to access sleep studies (these are now available bulk billed in many centres and home testing is also available)
Management problems e.g. failure of CPAP.

Sleep disorders

  • Obstructive sleep apnoea
  • Restless legs syndrome
  • Narcolepsy

Sleep apnoea

  • Affects 24% of middle aged men and 9% middle aged women.
  • Associated with snoring
  • Increased risk of Heart attacks
  • Increased risk of stroke
  • Affects QoL by:
    • Fatigue
    • Depression
    • Reduced libido
    • Poor concentration (inc risk of industrial accidents and MVAs)
  • Two types:
    • Obstructive sleep apnoea (caused by repetitive collapse of the upper airway)
    • Central sleep apnoea (caused by decreased output from ventilatory control centres in the brain)

Interpretation of sleep studies

  • Apnoea Hypopnoea Index (AHI) is the number of apnoeas (complete cessation of airflow) plus hypopnoeas (50% reduction in airflow associated with oxygen desaturation and/or arousal from sleep), divided by the number of hours of recorded sleep.
  • An AHI of 5 or greater indicates the presence of OSA
    • >30 indicates severe OSA

Risk factors for OSA

  • Male gender
  • Increasing age
  • Body Mass Index > 30
  • Neck circumference > 42 cm
  • Enlarged tonsils
  • Alcohol
  • Smoking
  • Post-menopause
  • Sleeping tablets

Treatments

  • Lifestyle
    • Weight loss
    • Smoking cessation
    • Alcohol reduction
    • Avoid sleeping in supine position
  • Mandibular advancement splints
    • These pull the mandible and hence the tongue forward reducing obstruction
  • Continuous positive airways pressure ventilation (CPAP)
    • This is the gold standard of treatment
    • Use nasal or oronasal mask
    • Can improve
      • Cognitive function
      • Hypertension
      • Cardiovascular risk
      • Improve QoL
  • Surgery
    • Tonsillectomy if tonsils are large
    • Uvulopalatopharyngoplasty (UPPP) may improve snoring but is less likely to cure OSA

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Reason for referral
  • History of sleep disorder
    • Duration
    • Severity of symptoms
      • E.g. day time somnolence
  • Management to date
    • Include last two specialist letters if seen previously at another centre
  • Other relevant medical conditions
    • Obesity
  • Occupation especially if involves driving or operation of heavy machinery (commercial license)
  • Medications
    • Include previously tried medications and appliances (mandibular advancement splint, CPAP) if associated with treatment failure or problems
    • Include full medication list and allergies
  • Investigations
    • FBC
    • Spirometry
    • CXR
    • Include full results of any previous sleep studies

Out of catchment!

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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