Obstructive Sleep Apnoea Syndrome

Assess the symptoms above in the history.

Examine for contributing/exacerbating factors:

• BMI
• BP
• Neck circumference (collar size)
• Micrognathia (small jaw)/retrognathia (abnormal jaw positioning with mandible set back from the maxilla)
• Signs of respiratory disease

Bloods:

• FBC, U&E, TFT, HbA1c, ferritin, B12, bicarbonate (a normal bicarbonate is helpful in suggesting against ventilatory failure)

Scores can be helpful. An Epworth score of > 10 suggests 'abnormal' somnolence. 

Patients should be advised about driving - Recommendation is that patients with daytime somnolence suspected to be due to OSAS should not drive. They should be directed to DVLA sleepiness guidance - 'Tiredness can kill: Advice for drivers (INF159)'. They should not be advised to notify DVLA until the diagnosis is confirmed.

• Patients with overweight or obesity should be advised on weight loss. 10-15% weight loss results in a 50% reduction in OSAS symptoms so weight loss should be the key treatment for these patients, including referral to weight management clinic, if appropriate.
• Advise stopping smoking
• Advise reducing alcohol
• Advise on sleep hygiene (Sleepio app can be helpful)

Refer patients with abnormal Epworth score (>10) and history suggestive of OSAS to sleep clinic via SCI Gateway...DGRI...Respiratory Medicine...Sleep Study

Patients with normal Epworth score (< 11) but still with a very good history of apnoeas and history suggestive of OSAS, particularly those who you feel may be minimising their symptoms.

Useful information in referral letter (helps with prioritisation):

• Are they a professional driver?
• Documented Epworth score
• Details of significant co-morbidities such as unstable cardiac disease
• Document that you have advised re driving
• Details of sleep pattern - patients with erratic sleep patterns as cause of sleepiness should deal with that first

Patients who are professional drivers or with significant co-morbidities will be seen urgently so it is important to ensure this is clear in the referral.

Do not refer:

• Patients with insomnia
• Patients with poor sleep hygiene/erratic sleep patterns as cause for sleepiness
• Patients with snoring alone
• Patients under 16 - refer to paediatrics instead

It is best to discuss patients with a potential parasomnia with respiratory first as they may be best referred to the tertiary sleep clinic in Edinburgh.