When should I consider referring a patient with central sleep apnea to a specialist for further evaluation or treatment?

Consider referring a patient with central sleep apnea to a specialist for further evaluation or treatment if:

• They have symptoms impacting safety-critical roles such as professional driving, piloting, or operating dangerous machinery, requiring urgent assessment to manage risks and advise on driving restrictions.
• They have significant comorbid cardiopulmonary conditions such as chronic obstructive pulmonary disease (COPD), poorly controlled arrhythmia, nocturnal angina, heart failure, treatment-resistant hypertension, pulmonary hypertension, or respiratory failure, which increase disease burden and mortality risk.
• They are pregnant or undergoing pre-operative assessment for major surgery, situations that warrant priority evaluation.
• They present with non-arteritic anterior ischaemic optic neuropathy, a condition linked to sleep apnea requiring specialist input.
• There is diagnostic uncertainty or treatment in primary care has failed, especially if symptoms persist or worsen.
• They have occupational risks or comorbidities that necessitate rapid specialist assessment and management.

Referral should include detailed clinical information such as assessment scores, impact of sleepiness, comorbidities, occupational risks, and any available oxygen saturation or blood gas results to facilitate prioritisation and appropriate specialist evaluation.

Specialist assessment may involve polysomnography or respiratory polygraphy to confirm diagnosis and guide treatment, including consideration of continuous positive airway pressure (CPAP) therapy or other interventions.

These recommendations align with NICE guidelines and expert consensus on managing sleep-disordered breathing, emphasizing timely referral for patients with central sleep apnea who have significant symptoms, comorbidities, or safety concerns ¹,²,³.