Category
Threshold Criteria
Obstructive Sleep Apnoea/Hypopnoea Syndrome (OSAHS) is part of a spectrum of sleep disordered breathing that also includes upper airway resistance syndrome and simple snoring. More than just a matter of disturbing a partner’s sleep, OSAHS also leads to impaired daytime function, poor work productivity, irritability, depression and loss of libido. The associated wake-time sleepiness can lead to accidents when driving or operating dangerous machinery. Additionally, there is increasing evidence of an association with the metabolic syndrome including obesity, diabetes, hypertension and increased risk of myocardial infarct and stoke. OSAHS has implications for drivers, both category 1 and 2 (HGV, PSV) licence holders
Patients who snore need to be assessed to see if they are likely to have OSAHS, this includes a history and physical examination and completion of the Berlin Questionnaire (to assess risk) and the Epworth Sleepiness Score ( an indication of impaired daytime function).
The Berlin Questionnaire separates patients into high and low risk for OSAHS. It consists of 3 domains; snoring, sleepiness/fatigue and risk factors. A positive response in 2 or more domains is indicative of high risk for OSAHS. Patients may need some help with this questionnaire since a calculation of BMI is required (see Appendix 2, Berlin Questionnaire).
All patients suspected of having OSAHS should complete an Epworth Score questionnaire. Where possible, their partner should be asked to give a second opinion. This is because patients do not always fully appreciate the extent to which they are affected (see Appendix 1, Epworth Sleepiness Score). Any elevation in the ESS has implications for the patient’s safety, life expectancy and quality of life. If not readily attributable to reduced opportunity for sleep, then a referral to a Sleep Centre may be appropriate.
Patients with a normal ESS and low risk on the Berlin Score should not normally be considered for referral to the Sleep Service. They should be provided (where appropriate) with counselling and information leaflets on the self-management of simple snoring, sedative and alcohol avoidance, weight loss, smoking cessation and the use of a mandibular repositioning device (MRD) or mandibular splint. All such patients should also be warned about the dangers of driving while sleepy.
Eligibility
| LLR ICB will support referral to the Sleep Centre for the following patients. All patients considered ‘high risk’ by the Berlin Score should be referred to a Sleep Centre for further investigation and possible treatment. A high Epworth Score is an indication of impaired daytime function and may suggest a more urgent referral. Urgent referral should be considered under the following circumstances: · The combination of severe OSAHS and COPD · Patients with symptoms suggestive of OSAHS who are sleepy while driving or working with machinery, or who are employed in hazardous occupations. · Patients with symptoms suggestive of OSAHS and who have evidence of ventilatory failure. |
Guidance
| Johns MW. A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 1991;14:540-5 Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the Sleep Apnoea Syndrome. Annals of Internal Medicine 1999; 131:485-91 Scottish Intercollegiate Guidelines Network (SIGN). Management of Obstructive Sleep Apnoea/Hypopnoea Syndrome in Adults: a national clinical guideline. SIGN guideline 73, 2003. www.sign.ac.ukLLR PCT for UHL 0809 Contract Section C4-4g PCT Questionnaires and information-snoring referral v3 – 0809.doc |
| ARP 88 Review Date: 2026 |
English 
Polish 
Romanian 
Arabic 
Gujarati 
Panjabi 
Urdu 