When is it appropriate to refer a patient with suspected narcolepsy to a sleep specialist for further evaluation?

It is appropriate to refer a patient with suspected narcolepsy to a sleep specialist for further evaluation when they present with unexplained excessive daytime sleepiness that cannot be attributed to other common sleep disorders such as obstructive sleep apnoea/hypopnoea syndrome (OSAHS) or obesity hypoventilation syndrome (OHS), and when initial assessments (including sleep history and sleepiness scales) suggest a significant impact on daily functioning.

Since the provided UK guidelines focus primarily on OSAHS and OHS, they do not explicitly detail referral criteria for narcolepsy. However, by analogy, referral to a sleep specialist is warranted when a patient has persistent, unexplained excessive sleepiness despite initial assessment and management of other common causes, or when symptoms such as cataplexy, sleep paralysis, or hypnagogic hallucinations are reported, which are characteristic of narcolepsy.

In practice, a general practitioner should consider referral if the patient’s excessive sleepiness is severe, unexplained, or associated with other narcolepsy symptoms, or if the diagnosis is uncertain after initial evaluation. This ensures specialist sleep services can perform detailed investigations such as polysomnography and multiple sleep latency testing to confirm narcolepsy.