Sleep disordered breathing / obstructive sleep apnoea Referral Access Criteria

Referrers should use this page when referring patients to public paediatric ENT outpatient services for sleep disordered breathing/obstructive sleep apnoea. This RAC is applicable to referrals for patients aged <16 years only. Please refer to the ENT (Adult) RAC for referrals for patients aged 16 years or more.

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Foreign body (button batteries – inhaled or ingested). if suspicion of button battery immediate emergency review
  • Acutely enlarging neck mass with any associated airway symptoms e.g., stridor, drooling, dysphagia etc
  • Airway compromise: severe stridor/drooling/ breathing difficulty/acute, sudden voice change/ severe odynophagia
  • Trauma
  • Abscess or haematoma (e.g., peritonsillar, parapharyngeal (quinsy), salivary, neck or retropharyngeal abscess)
  • Post-tonsillectomy haemorrhage
  • Hoarseness associated with neck trauma or surgery
  • If new onset hoarse voice and any airway obstructive symptoms             
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate paediatric ENT assessment (seen within 7 days):
  • Clinical concern regarding prolonged apnoea’s, cyanosis, altered level of consciousness or significant and escalating parental concerns should prompt direct phone contact with the ENT registrar on call to discuss the case and arrange review as clinically appropriate
To contact the relevant service, see HealthPathways: Acute Paediatric ENT assessment (external site)
Presenting issues
 If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Sleep disordered breathing/obstructive sleep apnoea 
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test due to financial reasons or geographical location).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

History
  •  Relevant history and description of sleep disordered breathing/obstructive sleep apnoea
Examination
  • Tonsillar hypertrophy grading scale (Brodsky scale)
  • Total OSA-5 score calculated as per the table below:

During the past 4 weeks, how often has the child had: None of the time  Some of the time  Most of the time  All of the time 
 1. Loud snoring  0
 2. Breath holding spells or pauses in breathing at night  0
 3. Choking or made gasping sounds while sleeping  0
 4. Mouth breathing because of a blocked nose  0
 5. Breathing problems during sleep that made you worried that they were not getting enough air  0

 

Investigations
  • Nil
Highly desirable
History
  • Obstructive sleep apnoea with co-existing craniofacial abnormality
  • Recent paediatric polysomnography
Examination
  • Paediatric Epworth/pictorial Sleepiness Scale
Investigations
  • Nil            
Indicative triage category

Category 1

Appointment within 30 days           

  • No defined category 1 criteria 

Category 2

Appointment within 90 days

  • Severe obstructive sleep apnoea
  • Obstructive sleep apnoea with faltering growth (failure to thrive)

Category 3

Appointment within 365 days

  • Sleep disordered breathing/obstructive sleep apnoea
  • Upper airway obstruction due to adenoid or tonsil hypertrophy
  • Nasal obstruction and snoring
Exclusions
  • Nil
Useful information
  • The Brodsky Scale (external site) assists in gauging the severity of tonsil enlargement. The Brodsky Scale encompasses:
    • Grade 0 - tonsils within tonsillar fossa/removed
    • Grade 1 - tonsils just outside tonsillar fossa and occupy <25% of the oropharyngeal width
    • Grade 2 - tonsils occupy between 26% and 50% of the oropharyngeal width
    • Grade 3 - tonsils occupy between 51% and 75% of the oropharyngeal width
    • Grade 4 - tonsils occupy >75% of the oropharyngeal width

Feedback

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Last reviewed: 27-05-2024