Development group members and reviewers listed Methodology detailed. Appendix 1 – Quick reference guide
Evidence Based Healthcare Guideline
USA
Management of Obstructive Sleep Apnoea/Hypopnoea Syndrome in Adults Covers: definition & clinical background ; diagnosis inc. diagnostic tools ; treatment ; referral ; effects of treatment on quality of life ; information for discussion with patients and carers ; resource implications of recommendations. Diagnosis and Management of Obstructive Sleep Apnoea
Institute for Clinical Systems Improvement
2004
Adults
Adults
See Appendix 2a for diagnostic algorithm Appendix 2b: treatment algorithm. Appendix 2c: signs and symptoms and recommendations.
Expert group selected by the Section on Paediatric Pulmonology of the American Academy of Paediatrics.
2002
Laitinen – (Expert group appointed by the Finnish Lung Health Association
Children with uncomplicated Obstructive Sleep Apnoea Syndrome (OSAS) - USA
Adults with sleep apnoea – Finland
Framework for diagnostic decision making. Includes definition of OSAS in children and risk factors; prevalence and progression of condition, diagnosis, treatment options and follow-up. Excludes: infantsor = to 5 apnoeas or hypopnoeas per hours’ sleep + 2 or more symptoms listed in Appendix 7a Appendix 7b – mild OSA and moderate to severe OSA symptoms listed
Reducing waiting times for sleep apnoea hypopnoea syndrome(SAHS) and snoring using a questionnaire and home oximetry: results of a 2nd audit cycle. Patients with suspected SAHS often referred to a variety of specialists. 1st audit of patient journey – identified lengthy delays – therefore an algorithm was formulated for management of respiratory sleep disorders and re-audited. Audit tools: questionnaire (to assess the risk – high moderate and low – therefore providing basis for further management) , Epworth Sleepiness Scale (ESS) and BMI. Results: new management strategy/algorithm - reduced average wait for sleep study by 90 days by prioritising patients. Reduced wait for nCPAP trial by 32 days. >50% reduction in ENT clinic visits.
References listed. It was noted there was a small increase in number of sleep studies performed and no increase in respiratory clinic workload. In 80% of patients, the only investigations required to make a diagnosis are the questionnaire used and overnight oximetry. Copy of the algorithm requested from authors as not included in paper – Appendix 8
Sparks
2002
Case Review
100 patients attending GP over 12 month period New Zealand
Assessment of snorers in primary care: straight path to treatment. Model for primary care management – based on sleepiness and nocturnal hypoxaemia. Problem: whether to refer patient suffering from disruptive snoring to a specialist (& how to decide which specialist) or to advise conservative treatment. Alternative investigations for primary care management • Partner reporting of snoring. • Excessive daytime sleepiness ( measured by Epworth Sleepiness Scale (ESS)). • Nocturnal hypoxaemia – measured by oxygen desaturation index (ODI). Combining both ESS and ODI will provide a system for grouping and subsequent management of potential OSA.
References listed. Model does not purport to diagnose patients with Obstructive Sleep Apnoea (OSA) specifically. Requires pulse oximetry
Appendix 1
Appendix 1 continued
Appendix 1 continued
Appendix 2a
Appendix 2b
Appendix 2c
Appendix 2d
Appendix 3a
Appendix 3b
Appendix 3b continued
Appendix 4a
Appendix 4b Checklist for GP when referring for sleep evaluation
Appendix 4c When should other specialists be consulted
