Sleep disordered breathing (suspected or confirmed)

• Decompensated hypercapnic respiratory failure

• Nil

To contact the relevant service, see Clinician Assist WA: Acute Respiratory assessment (external site).

• The following symptoms when other causes have been excluded:
  • Witnessed apnoeas
  • Snoring
  • Restless sleep (when not explained by another cause)
  • Unrefreshing sleep (when not explained by another cause)
  • Tiredness (when not explained by another cause)
  • Inappropriate falling asleep

Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

• Relevant history, onset, duration and severity of related symptoms
• Details of previous treatment and outcome, including any previously tried therapies (e.g. CPAP, mandibular advancement splint) and response
• Relevant past medical history e.g. cardiovascular disease
• Current medication list
• Any known allergies
• History of motor vehicle accidents or sleepiness/inattention when driving

• Height, weight and BMI
• Current Epworth Sleepiness Scale score
• If no previous sleep study, complete and provide score from any of the following: OSA-50, STOP-BANG or Berlin questionnaire

• If confirmed sleep apnoea, attach previous sleep study reports and any CPAP data (where available)

• Occupation
• Driving licence type
• Waist circumference

• Nil

• Nil

Category 1

Appointment within 30 days

• Suspected or confirmed sleep apnoea with any of the following:
  • Epworth Sleepiness Scale score ≥ 16
  • dozing while driving at least 1-2/month
  • MVA or work-related accident related to sleepiness/inattention in last 12 months
  • occupation affected and currently on light duties/unable to work
  • unstable cardiovascular disease e.g. overt heart failure
• Suspected or confirmed sleep hypoventilation with any of the following:
  • progressive neuromuscular disorder
  • established daytime hypercapnia (as demonstrated on ABG (if performed))
• Diagnostic sleep investigation demonstrating SpO2 ≤ 88% for > 1/3 of the night

Category 2

Appointment within 90 days

• Suspected or confirmed sleep apnoea with any of the following:
  • Epworth Sleepiness Scale score 12-15
  • dozing while driving in last 12 months
  • MVA or work-related accident related to sleepiness/inattention in last 5 years
  • occupation involving driving/heavy machinery operation
  • significant comorbidities for example pulmonary hypertension, previous stroke, heart failure
  • significant cardiac arrhythmias, neurological disease, acromegaly or hypothyroidism
• AHI ≥ 30 on a diagnostic sleep investigation

Category 3

Appointment within 365 days

• Suspected or confirmed sleep apnoea, parasomnias or sleep related movement disorders that does not meet criteria for Category 1 or 2 but still require specialist review

• Nil

• Referring doctor must assess immediate risk of driving and provide appropriate counselling based on Assessing Fitness to Drive Guidelines (including avoiding driving altogether if necessary).
• See HealthPathways: Sleep

Clinician resources

• National Sleep Diagnostics: Epworth Sleepiness Scale
• National Sleep Diagnostics: STOP-Bang questionnaire
• National Sleep Diagnostics: OSA-50
• National Sleep Diagnostics: Berlin questionnaire
• Australasian sleep association
• Australian Journal of General Practice: “Update on the assessment and investigation of adult obstructive sleep apnoea”