Sleep disordered breathing (suspected or confirmed)

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

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
- unstable cardiovascular disease eg 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 mean sleep saturation 85-90% (Mean sleep saturation <85% should ideally be seen within 2 weeks)

Category 2

Appointment within 90 days is desirable

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
- Respiratory Disturbance Index of ≥30 respiratory events per hour on a diagnostic sleep investigation

Category 3

Appointment within 365 days is desirable

Suspected or confirmed sleep disorders including chronic insomnia, circadian rhythm disorders, parasomnias or sleep related movement disorders that do not meet criteria for Category 1 or 2 but still require specialist review

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

Refer to HealthPathways for assessment and management information if available
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).

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History of sleep disorder including duration and severity of symptoms, snoring, witnessed apnoeas, restless sleep, unrefreshing sleep, tiredness, inappropriate falling asleep
Management to date including any previously tried appliances (mandibular advancement splint, CPAP) and response
Current medications
Epworth Sleepiness Scale score
Full report from all previous sleep investigations (if already performed)
Occupation
Driving licence type
History of motor vehicle accidents or sleepiness/inattention when driving

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.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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

Clinical Information (essential)

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