Scottish Sleep Forum Obstructive Sleep Apnoea Hypopnoea Syndrome (OSAS) Working towards the development of minimal standards for referral, investigation and treatment of OSAS in Scotland

OSAS Symptoms Snoring , witnessed apnoeic episodes, poor quality sleep, excessive daytime sleepiness Increased risk of RTA’s (up to x 12) Independent risk factor for hypertension → subsequent risk of stroke and MI’s

OSAS Common problem Prevalence of 2 – 4% in middle aged men 0.5 - 1% in middle aged women (similar to that of Type 1 diabetes and twice that of severe asthma) Fastest growing reason for new patient referrals in respiratory medicine Demand for sleep services now outstrips the capacity of the system throughout Scotland to cope

Scottish Sleep Forum Established in 2008 Multi-disciplinary group doctors, nurses, technicians, Representatives from throughout Scotland Meets twice per year in Stirling Co-chairs : Dr Robin Smith (Ninewells) Sr Phyllis Murphie (D&G)

Current Aim of Sleep Forum: To Develop Minimum Standards for OSAS Recommendations should be targeted to 5 areas Referral Standards Diagnostic and Treatment Standards Patient Review Standards National Core Data Set Driving Issues

Draft recommendations for each targeted area

Referral Standards There should be an agreed minimum dataset of information from the referring clinician New patient referrals should be risk stratified into urgent and routine categories New referrals should complete patient and partner questionnaires before being seen to allow background information on sleep related issues to be obtained Urgent patients may be best dealt with in a “one stop” clinic with a sleep study performed in advance – reducing administrative time

Diagnostic and Treatment Standards (1) A sleep study should be performed in those patients suspected of having OSAS The type of sleep study performed is of secondary importance to the experience and training of those interpreting the results but is usually some form of Respiratory PSG performed at home Hospital based PSG sleep studies should continue to be available in Edinburgh and Glasgow for more complex cases

Diagnostic and Treatment Standards (2) Weight reduction should always be encouraged in patients with a raised BMI CPAP is the treatment of choice for moderate and severe cases of OSAS MRS devices are an alternative treatment option for simple snorers or in those who cannot tolerate CPAP Palatal surgery is not recommended in OSAS

Patient Review Standards (1) Patients using CPAP should have access to advice and support from trained staff (dedicated nurse led follow up clinics, “drop – in” service or telephone helplines A blend of technician and nurse specialist support should be available Multidisciplinary team working is recommended A data base of patients should be maintained CPAP machines should be reclaimed if patients are not using them – this would improve cost efficiency

Patient Review Standards (2) Patients who are “low risk” and stable on CPAP may be discharged from routine follow up but need to have open access to an advice helpline and to a service providing replacement masks and parts as necessary CPAP compliance and troubleshooting issues may be able to be dealt with locally with the help of NHS 24 in the future – this would free capacity to allow more new referrals to be seen More complex “high risk” patients on CPAP (professional drivers, co-morbid problems) need regular face to face review Access to treatment other than CPAP (MRS, dietary advice) should be available

National Core Dataset This would facilitate improved outcomes Improve communication locally and nationally Allow comparison of current practice against Guidelines / Standards (SIGN 73 / IMPRESS 2009) Facilitate audit and research

Driving Issues Always ask about driving issues Give clear advice to the patient who is sleepy whilst driving (and to the GP) regarding their legal obligations

The Scottish Sleep Forum asks that the National Advisory Group for Respiratory MCN’s endorses this document to allow it to progress to the Scottish Government