referral guidelines for sleep apnoea and snoring patients - Plymouth ...

Nasal pathology needs exclusion. Look for:
‣ Nasal polyps
‣ Allergic rhinitis
‣ Deviated nasal septum
WHEN AND WHERE TO REFER:
Prior to referral the above differential diagnoses should be considered and
exacerbating factors such as obesity, alcohol, night sedation and smoking should be
corrected.
1. Snoring only: Do not refer to secondary care unless nasal pathology
indicated.
2. Significant OSA: Refer to the Chest Clinic after addressing risk
factors.
3. Hyper somnolence: Refer to Neurology.
PRIOR TO REFERRAL PLEASE CONSIDER THE FOLLOWING:
OSA
The available treatments for OSA are CPAP or mandibular splints. (Surgical
treatments have unpredictable results. It is possible that they might make the use of
CPAP more difficult).
These treatments are only suitable for moderate and severe cases, where
somnolence is significantly affecting lifestyle.
Patients usually only tolerate the treatment if they have sufficient somnolence to
impact on their quality of life. The degree of somnolence that warrants treatment is
therefore, determined by the patient and their lifestyle. The Epworth score is a
helpful measure, scores less than 12 are normal, 14 or more suggests moderate –
severe OSA. (See sample questionnaire).
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.
Review of risk factors often leads to improvement, particularly obesity and alcohol
excess. (Trials of Orlistat or Sibutramine are recommended together with dietary and
lifestyle advice)