Sleep apnoea

Obstructive sleep apnoea assessment, plan and referral

PATIENT DETAILS
Name: 
DOB: 
Address: 
Tel:

DATE:

SLEEP HISTORY
- Usual time of going to sleep: 
- Usual time of waking up: 
- Usual length of time to fall asleep:

USUAL SLEEP POSTURE/S
(-) supine
(-) prone
(-) side

PREDOMINANT POSTURE
(-) supine, (-) prone, (-) side, (-) uncertain

SLEEP HISTORY
(-) frequent night wakening
(-) unrefreshing sleep
(-) wake with dry throat
(-) restless legs at night
(-) use caffeine at night
(-) snore heavily
(-) choking sensation when sleeping
(-) wake with headache
(-) feel sleepy when driving
(-) problems with memory or concentration
(-) observed apnoea during sleep

PAST MEDICAL HISTORY
(-) T2DM
(-) stroke/TIA
(-) depression
(-) hypertension
(-) cardiovascular disease
(-) asthma/COPD
(-) epilepsy
(-) parasomnia

OTHER HISTORY
(-) Current smoking - cigarettes/day: 
(-) Current alcohol use - standard drinks per day:

CURRENT MEDICATION
-

EPWORTH SLEEPINESS SCALE

Codes: (chances of dozing off)
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

(Patient response) Situations:

0 <- Sitting and reading.
0 <- Watching TV.
0 <- Sitting, inactive in a public place (e.g. a theatre or meeting).
0 <- As a passenger in a car for an hour without a break.
0 <- Lying down to rest in the afternoon when circumstances permit.
0 <- Sitting and talking to someone.
0 <- Sitting quietly after a lunch without alcohol.
0 <- In a car, while stopped for a few minutes in the traffic.

TOTAL SCORE /24: ?

Score interpretation:
0-5 lower normal daytime sleepiness.
6-10 higher normal daytime sleepiness.
11-12 mild excessive daytime sleepiness.
13-15 moderate excessive daytime sleepiness.
16-24 severe excessive daytime sleepiness.

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STOP-BANG Score For Obstructive Sleep Apnoea:

(-) SNORING (Do you snore loudly; louder than talking or loud enough to be heard through closed doors?)
(-) TIRED (Do you often feel tired, fatigued, or sleepy during daytime?)
(-) OBSERVED (Has anyone observed you stop breathing during your sleep?)
(-) BLOOD PRESSURE (Do you have or are you being treated for high blood pressure?)
(-) BMI (More than 35 kg/m2?)
(-) AGE (> 50 years?)
(-) NECK CIRCUMFERENCE (Measured > than 40 cm?)
(-) GENDER (male?)

SCORE (number of "+" responses): ?

Score interpretation:
0-2 low risk of OSA.
3+ high risk of OSA.

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OSA OBSTRUCTIVE SLEEP APNOEA - 50 SCREENING

(-) Waist circumference > 102 cm (male) or > 88 (female) - score 3.
(-) Has your snoring ever bothered people? - score 3.
(-) Has anyone noticed that you stop breathing during sleep? - score 2.
(-) Age 50+ years - score 2.

TOTAL SCORE /10: ?

Score interpretation:
5+ increased risk of OSA.

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PLAN/REFERRAL
(-) Refer for home sleep study^
   (-) Referrer to discuss results with patient and manage treatment
(-) Refer respiratory/sleep physician consultation
(-) Refer for ENT consultation

(-) CPAP/APAP trial
  (-) With oximetry
(-) Trial mandibular advancement splint (dentist supplied)
(-) Trial of positional avoidance

^ Contraindications to home sleep study (criteria for in laboratory sleep study):
(-) Unsuitable home environment.
(-) Physical, intellectual or cognitive impairment without necessary carer support.
(-) Neuromuscular disease, heart failure, significant respiratory disease, suspected parasomnia or seizure disorder.
(-) Suspected central sleep apnoea syndrome.
(-) Suspected sleep hypoventilation syndrome.
(-) Previously failed or inconclusive home sleep study.

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REFERRING DOCTOR DETAILS
Name: 
Address: 
Tel: 
Email: 
Provider no.:

REFERRING DOCTOR SIGNATURE

Notes

Medicare Australia sleep study eligibility criteria:

ESS ≥8 AND
STOPBANG ≥ 3 OR
OSA 50 ≥ 5

References:

https://epworthsleepinessscale.com/about-the-ess/
Frances Chung, Balaji Yegneswaran, Pu Liao, Sharon A. Chung, Santhira Vairavanathan, Sazzadul Islam, Ali Khajehdehi, Colin M. Shapiro. Anesthesiology 2008; 108:812–21.

Central sleep apnoea

Central sleep apnoeas are characterised by reduction or cessation of airflow due to absent or reduced respiratory effort. Central apnoea (cessation of airflow) or hypopnea (reduction in airflow) may occur in a cyclical or intermittent fashion. Patients with central sleep apnoea of various etiologies may also exhibit obstructive events, in which case diagnoses of both central sleep apnoea and obstructive sleep apnoea may be given. Note: A definitive diagnosis requires objective evidence based on polysomnography.

[ICD-11]

Obstructive sleep apnoea

Obstructive sleep apnoea is repetitive, episodic apnoea or hypopnoea during sleep causing reduction in blood oxygen saturation usually terminated by brief arousal from sleep. It is generally associated with excessive sleepiness.

Diagnosis is based on:

Obstructive events (apnoeas, hypopnoeas or respiratory-event related arousals) demonstrated on polysomnography (sleep study)
Symptoms of daytime sleepiness
Associated medical conditions
- Hypertension
- Mood disorders
- Cognitive dysfunction
- Coronary artery disease
- Atrial fibrillation
- Congestive heart failure (especially right-sided failure)
- Stroke
- Type 2 diabetes mellitus

[ICD-11]

Sleep apnoea

Notes

Central sleep apnoea

Obstructive sleep apnoea

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