What criteria should I use to refer a patient with suspected obstructive sleep apnoea to secondary care?

Refer a patient with suspected obstructive sleep apnoea to secondary care if they have suspected moderate or severe OSAS, or suspected mild OSAS that is impacting on their quality of life ².

Arrange urgent referral to a sleep clinic if the patient has excessive sleepiness impacting on safety-critical work, such as professional driving, or if they have comorbid conditions like COPD, poorly controlled arrhythmia, nocturnal angina, heart failure, treatment-resistant hypertension, pulmonary hypertension, or respiratory failure ².

In adults, also consider urgent referral if the patient has a BMI of 30 kg/m2 or more with features of OSAHS or nocturnal hypoventilation, or if they have features of nocturnal hypoventilation such as waking headaches, peripheral oedema, hypoxaemia, or unexplained polycythaemia ¹.

For children, refer to a paediatric ENT specialist if they have clinical features of nasopharyngeal obstruction such as adenotonsillar hypertrophy and regular snoring, or if they have a congenital or developmental disorder contributing to symptoms ².

Additionally, consider routine referral for further investigation if the suspected OSAS is moderate or severe, or if mild OSAS impacts quality of life ².