History and Examination

• Nasal obstruction

• Co­morbidity e.g. obesity, hypothyroidism, ischaemic heart disease, cerebrovascular disease, diabetes, hypertension

• Smoking history

• Alcohol consumption

• Medication history

• Consider psycho­social impact

• Assess
  • BMI
  • Nasal airway patency
  • Tonsil and tongue base

Symptoms or signs suggestive of oropharyngeal neoplasm e.g.: unilateral tonsil and tongue enlargement.

Please complete an Epworth Sleepiness Score.

Torbay and South Devon also require a completed Berlin Questionnaire.

Significant OSA causes daytime somnolence. This increases the risk of personal injury, especially when driving. Hypertension, strokes and myocardial infarction rates are all increased.

Other causes of daytime somnolence need exclusion. These include:

• Poor sleep habit
• Shift work
• Evening coffee
• Restless leg syndrome - consider referral to Neurology
• Narcolepsy - consider referral to Neurology

Prior to referral please consider the following:

The available treatments for OSA are CPAP (Continuous positive airway pressure therapy) or mandibular splints (surgical treatments have unpredictable results and it is possible they might make the use of CPAP more difficult.)

These treatments are only suitable for moderate and severe cases.

Patients usually only tolerate the treatment if they have sufficient somnolence to impact on their quality of life. The degree that warrants treatment is therefore determined by the patient and their lifestyle. The Epworth score is a helpful measure in conjunction with clinical assessment, scores less than 11 suggest sleep apnoea is unlikely, 14 or more suggests moderate – severe OSA.

Occasional nocturnal apnoeas may cause alarm to the sleeping partner but if the frequency is low then there will be no ensuing daytime somnolence and no need to treat. Reassurance without referral is sufficient.

Mild or occasional symptoms of OSA do not require referral as it is unlikely that treatment will be accepted. There is no evidence of long-term health risk for this group.

It is vital that patients with OSA and daytime sleepiness sufficient to impair driving, or the use of machinery, are warned of the risks and told to cease immediately, pending treatment.

Referral Criteria

Please note referral criteria (below) are applicable in this referral.

Referrals submitted without this information will be returned.

Completion of a referral form including Epworth score (and Berlin for T&SD) is a prerequisite of referral to this service.

Completed forms must be attached when the UBRN is created.

Please only refer patients with an Epworth Sleepiness Score of 12 or more,

Torbay and South Devon also require 2 or more domains positive on the Berlin Questionnaire.

Prior to referral exacerbating factors should be considered; Obesity, alcohol, night sedation and smoking should be corrected where possible.

Refer to Respiratory

• Snoring with an Epworth Sleepiness Score 12 or more

• For Torbay and South Devon service referrals:
  • 2 or more domains positive on the Berlin Questionnaire
  • Completion of referral forms (including Epworth Sleepiness score and Berlin) is a prerequisite of referral. These must be attached when the UBRN is created.

Consider referral to neurology

• If Hyper somnolence without OSA

Referral Instructions

Referral to Respiratory

e-Referral Service Selection

Specialty: Sleep Medicine

Clinic Type: Sleep Apnoea/Sleep Disordered Breathing

Service: DRSS-Western-Sleep Medicine-Devon CCG-15N

Refer to Neurology

e-Referral Service Selection

Specialty: Neurology

Clinic Type: Not Otherwise Specified

Service: DRSS-Western-Neurology-Devon CCG-15N

Referral Form

DRSS referral form

Torbay and South Devon forms

• Sleep apnoea referral form

• Berlin questionnaire

• Berlin questionnaire scoring

• Epworth sleepiness scale

Patient Information

My Health Devon

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: March 2019