Consider referral to a sleep physician for:
- Patients with suspected obstructive sleep apnoea or sleep hypoventilation, to confirm necessity for a sleep study, and discuss treatment options.
- Patients suffering from parasomnias (abnormal sleep behaviour).
- Patients who have significant comorbid conditions that may suggest underlying sleep apnoea, particularly if symptomatic, eg. pulmonary hypertension, uncontrolled hypertension or nocturnal hypertension, arrhythmias, unstable cardiovascular disease, coexistent respiratory disease, such as difficult to control asthma, cardiac failure, cerebrovascular disease, depression, cognitive decline, chronic cough.
- Patients who experienced drowsy driving.
- Patients who had a motor vehicle accident, near miss accident or workplace accident due to excessive daytime sleepiness.Patients who have persistent excessive daytime sleepiness to exclude a disorder of hypersomnolence such as narcolepsy or idiopathic hypersomnolence.
- Patients with restless legs.Implementation and supervision of CPAP therapy, ASV or BiPAP.
- Review post fitting and titration of mandibular advancement splint.
- Assessment of response to other therapy, such as nasal EPAP or body positioning manoeuvres.
- Poor responders to CPAP therapy.Commercial drivers with obstructive sleep apnoea syndrome, to assess ongoing fitness to drive.
- Patients with insomnia to avoid long-term use of sleeping tablets.