This page was last reviewed 22-05-20
Initial Assessment
The first step is to decide whether the patient is simply snoring or may have sleep disordered breathing.
Simple snoring: Lothian does not have a snorer’s service
Referral to ENT department should be considered if patient has significant nasal obstruction not relieved after prolonged (three months) course of nasal steroid sprays or has excessively enlarged tonsils. Palatal surgery for snoring is not recommended.
For suspected sleep apnoea syndrome: Refer to the Respiratory department if there is a disruptive excessive daytime sleepiness (Not Tiredness / Fatigue)
Physical signs:
- BMI >25
- Neck size 17 inches or larger
- Nasal congestion/blockage (permanent)
- Receding lower jaw
Calculate Epworth Sleepiness Score
To overcome the factors above we would recommend the following prior to referral
* Weight reduction
* Reduce or stop evening alcohol
* Relieve nasal congestion
Please be aware that other causes of daytime sleepiness include:
- Shift work
- Insomnia
- Depression
- Poor sleep hygiene (quality of sleep)
- Sleep deprivation (quantity of sleep)
- Narcolepsy
- Hypothyroidism
- Restless leg syndrome/periodic limb movement disorder
- Illicit use of drugs
- Prescribed medications
- Excess alcohol
- Neurological conditions
If patient does not meet the referral criteria but has experienced sleepiness in a dangerous situation, please discuss the patient with one of the Respiratory Consultants/Clinicians involved in OSAHS service delivery.
