Sleep Disorders

This condition is treated in the Respiratory and Sleep Medicine clinic.

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 Royal Hobart Hospital 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:

• BMI
• STOP-BANG score
• ESS score

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 HealthPathways Tasmania website.

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

Clinic appointments

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

Emergency

? acute respiratory failure
? clinical judgement

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Urgent (Category 1)

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

Epworth Sleepiness Scale - score greater than or equal to 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 greater than or equal to 16) not attributed to inadequate sleep hygiene or environmental factors

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 (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 greater than or equal to 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 greater than or equal to 12) not attributed to inadequate sleep hygiene or environmental factors

Routine (Category 3)

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

Next available appointment.

Availability

North

Launceston General Hospital
Level 3 - Specialist Clinics

Phone: 1300 977 694
Fax: 03 6777 5227

North West

North West Regional Hospital
Phone: 03 6493 6300
Fax: 03 6464 1928

Mersey Community Hospital
Phone: 1800 636 455 
Fax: 03 6441 5928

Smoking Cessation (nursing service)
Burnie Community Health
11 Jones Street, Burnie
Phone: 03 6477 7350
and
Mersey Community Hospital
Phone: 03 6478 5251 or 03 6478 5222
Fax: 03 6441 5928

South

Respiratory Clinic including urgent referrals (please mark as urgent)
Phone: 03 6166 0000
Fax: 03 6234 3982

Respiratory Lung Function Testing (technician)
Phone: 03 6166 0042 
Fax: 03 6234 3982

Cystic Fibrosis (CF)
Phone the CF coordinator via the switchboard on 03 6166 8308

Possible TB (please mark Attention Dr David Stock)
Phone: 03 6166 8438
Fax: 03 6173 0462

Locations:

• Wellington Clinics (Level 10)
• Telstra Building (Level 5 - Cystic Fibrosis Clinic)
• Clarence Integrated Health Centre