Sleep Disorders

The Department will periodically contact patients waiting for an outpatient clinic appointment via SMS, with a link to an electronic form.  This is part of routine waitlist auditing to ensure patient details are up to date.  If you receive this SMS, please update your details.

Availability

North South North West Statewide

Pre-referral work-up

History

The sleep disorders clinic is specifically for the investigation and management of people holding current Health Care Cards or Commonwealth Seniors Health Cards with suspected sleep apnoea who have evidence of a high probability of sleep apnoea as identified by formal questionnaires.

All referrals (see RHH Sleep Clinic Referral template and Frequently Asked Questions or Primary Health Tasmania downloadable referral) should comply with the Referral Standards and specifically include:

  • History of presenting symptoms including treatments tried
  • Current medical conditions and relevant past history
  • Current medications list
  • Concession card information must be included
  • Examination findings including ENT findings
  • Smoking history

Tests

Pathology:

  • TFTs
  • U&E
  • BSL (Fasting) or HbA1c
  • Iron studies (suspected restless legs or fatigue)
  • Vitamin D (if fatigued)

Imaging:

  • Nil

Investigations:

Interim/GP management

To refer a patient with this condition, please see the Respiratory and Sleep Medicine clinic page for the full referral process and templates.

Referrals will be triaged according to the information supplied, with some patients being directly straight to sleep studies and some patients being seen in clinic first.  Referrals with insufficient information will be returned to the referrer.

Where possible consider reducing narcotic and benzodiazepine use.  Advise weight loss if possible.  Manage comorbidities e.g. hypertension.

People without Health care cards and Commonwealth Seniors Health cards are not eligible for this service and will require assessment in the private sector.

For more information please see the Tasmanian Health Pathways website.

Emergency

acute respiratory failure
clinical judgement

Urgent / category 1

suspected or confirmed sleep apnoea with any of the following (please also select)

Epworth Sleepiness Scale - score ≥ 16
Dozing while driving at least 1-2/month
MVA or work-related accident related to sleepiness in last 12 months
unstable cardiovascular disease e.g. overt heart failure

suspected or confirmed sleep hypoventilation with any of the following (please also select):

progressive neuromuscular disorder
established daytime hypercapnia (as demonstrated on ABG (if performed)
diagnostic sleep investigation

unexplained hypersomnolence (Epworth Sleepiness Scale score ≥ 16) not attributed to inadequate sleep hygiene or environmental factors

Semi-urgent / category 2

suspected or confirmed sleep apnoea with any of the following (please also select)

Epworth Sleepiness Scale - score 12 - 15
Dozing while driving in the last 12 months
MVA or work-related accident related to sleepiness in the last 5 years
occupation involving driving/heavy machinery operation
significant comorbidities for example pulmonary hypertension, previous stroke, heart failure 
significant cardiac arrhythmias, neurological disease, acromegaly or hypothyroidism

Respiratory Disturbance Index of ≥ 30 respiratory events per hour on a diagnostic sleep investigation
Suspected or confirmed narcolepsy
Suspected or confirmed parasomnia or nocturnal seizures with injury to self or others
Suspected or confirmed sleep related movement disorder with injury to self or others
Unexplained hypersomnolence
(Epworth Sleepiness Scale score ≥ 12) not attributed to inadequate sleep hygiene or environmental factors

Routine / category 3

Suspected or confirmed sleep disorders
Epworth Sleepiness Scale score 8-11

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Additional Information

  1. History of sleep disorder including duration and severity of symptoms, snoring, witnessed apnoeas, restless sleep, unrefreshing sleep, tiredness, inappropriate falling asleep
  2. Management to date including any previously tried appliances (mandibular advancement splint, CPAP) and response
  3. Current medications
  4. Full report from all previous sleep investigations (if already performed)
  5. Occupation
  6. Driving licence type
  7. History of motor vehicle accidents or sleepiness/inattention when driving
  8. Medical History (specifically flag Diabetes, Atrial Fib, Cardiac Failure, Stroke/TIA, COPD)
  9. STOP-BANG score
  10. ESS score
Emergency:

Proceed to Emergency Department (ED).
LGH ED Reception  – Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED* – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED* – Phone: (03) 6493 6351 Fax: (03) 6464 1926
RHH ED Reception – Phone: (03) 6166 6100  Fax: (03) 6173 0489

Advice for medical practitioners can be given by the Medical Officer In Charge (MOIC) - see HealthPathways Tasmania for contact information.
*MCH and NWRH MOICs request GPs call them prior to referring a patient to ensure the patient is being sent appropriately to a safe destination.

Urgent:

We will endeavour to see these patients within four weeks.

Patients with suspected lung cancer will be seen within one week.

Urgent referrals should be accompanied by a phone call to the Respiratory Department and/or the relevant doctor for urgent assessment.

Semi-urgent:

We will endeavour to see these patients within 12 weeks.

Routine:

Next available appointment.