Refer a patient with suspected obstructive sleep apnoea to secondary care if they have suspected moderate or severe OSAS, or suspected mild OSAS that is impacting on their quality of life NICE CKS.
Arrange urgent referral to a sleep clinic if the patient has excessive sleepiness impacting on safety-critical work, such as professional driving, or if they have comorbid conditions like COPD, poorly controlled arrhythmia, nocturnal angina, heart failure, treatment-resistant hypertension, pulmonary hypertension, or respiratory failure NICE CKS.
In adults, also consider urgent referral if the patient has a BMI of 30 kg/m2 or more with features of OSAHS or nocturnal hypoventilation, or if they have features of nocturnal hypoventilation such as waking headaches, peripheral oedema, hypoxaemia, or unexplained polycythaemia NICE NG202.
For children, refer to a paediatric ENT specialist if they have clinical features of nasopharyngeal obstruction such as adenotonsillar hypertrophy and regular snoring, or if they have a congenital or developmental disorder contributing to symptoms NICE CKS.
Additionally, consider routine referral for further investigation if the suspected OSAS is moderate or severe, or if mild OSAS impacts quality of life NICE CKS.