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

Please follow the link below to access a questionaire to quantify your patients level of sleepiness.

Epworth Sleepiness Scale

Interpretation:
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