Sleep Apnea Referral Guidelines

Obstructive Sleep Apnea

Diagnosis/Definition

Obstructive Sleep Apnea (OSA) is defined as recurrent partial/complete obstructions of the upper airway that produce sleep disruption that can lead to multiple negative consequences such as excessive daytime sleepiness, mood disorders, hypertension, and other cardiovascular problems such as heart disease and stroke.

Initial Diagnosis and Management

A patient is suspected of having Obstructive Sleep Apnea will have some/all of following signs and symptoms:

• Habitual snoring: defined as loud snoring consistently every night
• Witnessed apneas: defined as repeated obstructive breathing events while asleep
• Excessive daytime sleepiness
• Obesity / Overweight– a strong risk factor for OSA
• Large tonsils and/or adenoids on physical exam
• A Craniofacial Syndrome such as Down’s Syndrome or Pierre Robin Sequence
• Motor vehicle accident related to sleepiness
• Work or social impairment related to sleepiness
• Neck size greater than 17 inches in men and 15 inches in females
• Hypertension that is not controlled on two medications
• Congestive Heart Failure 

For ADULTS, the ability to diagnose OSA in the clinic is limited and therefore, all adult patients who have signs or symptoms of OSA should have an overnight sleep study (polysomnogram) before any treatment is initiated.

Initial management strategies for OSA for ADULTS are typically MEDICAL treatments:

• Weight loss
• Continuous Positive Airway Pressure device (CPAP)
• Oral / dental appliance
• Positional therapy – special pillows, etc. 

Initial management strategies for OSA for CHILDREN are typically SURGICAL treatments:

• Removal of tonsils / Adenoids
• Turbinate reduction

Ongoing Management and Objectives

• For adult patients who cannot successfully complete medical treatments for OSA, surgery may be an option to control their OSA or help them better tolerate medical treatments
• All adult patients will have to have an overnight sleep study (polysomnogram) prior to proceeding for possible surgical management of their OSA
• For children who still have signs or symptoms of OSA after tonsil/adenoid surgery additional surgical or medical treatments may be effective

Indications for Specialty Care Referral

• All Active Duty members with sleep problems to include heroic snoring, excessive daytime somnolence, insomnia or other sleep concerns
• Children with the signs and/or symptoms of OSA
• Patients that fail to respond to medical treatments for OSA (CPAP, dental appliance) and desire possible surgery to treat their OSA
• Patients with or without OSAS who have socially bothersome snoring. Multiple treatments are available for this problem.