Sleep disordered breathing (suspected or confirmed)
Adult

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Emergency Referrals

Important

If you believe your patient requires immediate attention, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice.

Acute exacerbation of asthma not responding to therapy
Asthma with any of the following concerning features:
- coexistent pneumothorax
- pneumonia
- silent chest
- cardiovascular compromise
- altered consciousness
- relative bradycardia
- decreasing rate and depth of breathing
Bronchiectasis / CSLD with any of the following concerning features:
- altered consciousness
- hypoxia (<90% oxygen saturation) when this is not normal for the patient
- evidence of significant infective exacerbation (fever and/or high-volume purulent sputum
- new hemoptysis (clots or more than streaks
- new CXR changes indicative of cavitation, consolidation or pneumonia
Chronic obstructive pulmonary disease (COPD)
- Acute exacerbation not responding to outpatient therapy
- Acute respiratory failure
Cystic fibrosis with any of the following concerning features:
- respiratory distress
- new hemoptysis (clots or more than streaks)
- pleural effusion
- consolidation/pneumonia/fever
- non- response to antibiotics for chest infection
Significant haemoptysis defined as repeated expectoration of 5mL (1tsp) of blood or single episode of >20mL (1tbsp)
Any haemoptysis with acute dyspnoea, measured hypoxia, altered consciousness, hypotension, tachycardia or chest pain
Acute exacerbations of known ILD with any of the following concerning features:
- severely breathless/Class 4 dyspnoea  (ADL’s affected by dyspnoea)
- demonstrated worsening hypoxemia
- new arrhythmia/chest pain
Newly diagnosed or suspected ILD with radiographic evidence with Class 4 dyspnoea  (ADLs affected by dyspnoea
Suspected or known lung cancer with any of the following concerning features:
- massive haemoptysis
- suspected large airway obstruction
- severe dyspnoea
- SVC obstruction
- hypercalcemia/hyponatremia with confusion
- symptomatic pleural effusion
Large symptomatic pleural effusion
Acute pneumothorax
Acute decompensation (hypoxia or right heart failure) with pulmonary hypertension
Pulmonary embolism
Dyspnoea of uncertain origin with any of the following concerning features:
- acute dyspnoea at rest
- demonstrated hypoxia (SpO2 < 90%)
- accompanied by confusion
Suspected tuberculosis with significant haemoptysis (defined as repeated expectoration of 5mL (1tsp) of blood or single episode of >20mL (1tbsp)

Useful Management Information

Referring doctor must assess immediate risk of driving and provide appropriate counselling based on Assessing Fitness to Drive Guidelines (including avoiding driving altogether if necessary).

Clinician resources

Australasian sleep association
Queensland Government - Assessing fitness to drive
National Institutes of Health information site
Health Direct Australia  Government website with many trusted information links

Patient resources

Sleep health foundation

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Suspected or confirmed sleep apnoea with any of the following: Epworth Sleepiness Scale  score ≥ 16 dozing while driving at least 1-2/month MVA or work-related accident related to sleepiness/inattention in last 12 months unstable cardiovascular disease e.g. overt heart failure Suspected or confirmed sleep hypoventilation with any of the following: progressive neuromuscular disorder established daytime hypercapnia (as demonstrated on ABG (if performed)) diagnostic sleep investigation demonstrating mean sleep saturation 85-90% (Mean sleep saturation <85% should ideally be seen within 2 weeks)
Category 2 (appointment within 90 calendar days)	Suspected or confirmed sleep apnoea with any of the following: Epworth Sleepiness Scale  score 12-15 dozing while driving in last 12 months MVA or work-related accident related to sleepiness/inattention in 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
Category 3 (appointment within 365 calendar days)	Suspected or confirmed sleep disorders, including chronic insomnia, circadian rhythm disorders, parasomnias or sleep related movement disorders that do not meet criteria for Category 1 or 2 but still require specialist review
If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service.

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

History of sleep disorder including duration and severity of symptoms, snoring, witnessed apnoeas, restless sleep, unrefreshing sleep, tiredness, inappropriate falling asleep
Management to date including any previously tried appliances (mandibular advancement splint, CPAP) and response
Current medications
Epworth Sleepiness Scale  score
Full report from all previous sleep investigations (if already performed)
Occupation
Driving license type
History of motor vehicle accidents or sleepiness/inattention when driving

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

No additional referral information

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Respiratory (E-Blueslips)
Sleep Clinic Adult (E-Blueslips)

Fax

(07) 5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Maninder Singh

Medical Director Respiratory and Sleep Medicine

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Sleep disordered breathing (suspected or confirmed)Adult