Respiratory Referral Guidelines
Referral guidelines for patients with possible lung cancer
Please view the information under 'Choose and Book - Referral Forms' where you will find the 2 week wait referral form for suspected lung cancer.
Referral guidelines for patients with possible sleep apnoea
Clinicians should assess the likelihood of a patient having sleep apnoea based on the following:
1. History
Cardinal Features:
Excessive daytime sleepiness despite an adequate amount of time in bed asleep.
Is the patient falling asleep against their will?
Is the patient falling asleep at work?
Is the patient falling asleep whilst driving?
Other features consistent with sleep apnoea: Predisposing factors:
Snoring Increasing age
Unrefreshed on waking Male gender
Choking episodes at night Obesity
Witnessed apnoeas Sedative drugs
Nocturia Smoking
Impaired memory/concentration Alcohol consumption
2. Examination
The following make the diagnosis more likely:
Obesity (collar size >17 inches)
Large tonsils
Retrognathia
Poor nasal patency
Exclude/Consider other causes of daytime sleepiness:
Depression (difficulty getting to sleep and early waking)
Narcolepsy (usually sleepy from a young age)
Periodic Limb Movement disorder (history of leg jerks during sleep from partner)
Neurological conditions (previous head injury, previous encephalitis)
Associations:
Myxoedema
Acromegaly
Hypertension
Neuromuscular Disease
3. Management
Patients who are suspected of having sleep apnoea should be referred to the respiratory physicians who will generally organise a sleep study.
Patients who snore and are not sleepy should be referred to the ENT surgeons.
Patients who are overweight should be encouraged to lose weight. These patients should still be referred if they are significantly sleepy (Epworth Score 12+).
All patients should moderate alcohol intake and stop smoking.
4. Subjective Assessment of Sleepiness
Epworth Sleepiness Score
How likely are you to doze off or fall asleep, in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation.
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
| Situation |
Chance of Dozing |
| Sitting and reading |
|
| Watching TV |
|
Sitting, inactive in a public place
(eg a theatre or a meeting) |
|
| As a passenger in a car for an hour without a break |
|
Lying down to rest in the afternoon when
circumstances permit |
|
| Sitting and talking to someone |
|
| Sitting quietly after a lunch without alcohol |
|
| In a car, while stopped for a few minutes in traffic |
|
| TOTAL |
|
Normal <11, Mild 11-14, Moderate 15-18, Severe 18+
Ian Mortimore/ Jeff Meecham Jones 2007
Points to consider before making a referral for sleep apnoea
1. Is the patient sleepy despite spending an adequate amount of time in bed (asleep).
2. Are there any other factors likely to interfere with sleep (shift work, anxiety/depression, drugs)
3. Assess Epworth score (a score in single figures makes the diagnosis less likely).
Ian Mortimore 2009