What are the indications for referring a patient with suspected narcolepsy to a sleep specialist?

Indications for referring a patient with suspected narcolepsy to a sleep specialist include:

• Presence of excessive daytime sleepiness that is unexplained by other causes.
• Symptoms suggestive of narcolepsy such as sudden muscle weakness (cataplexy), sleep paralysis, hypnagogic hallucinations, or disrupted nocturnal sleep.
• Failure to identify other common causes of excessive sleepiness such as obstructive sleep apnoea/hypopnoea syndrome (OSAHS) or obesity hypoventilation syndrome (OHS) after initial assessment.
• Significant impact of sleepiness on daily functioning or occupational safety, especially in jobs requiring vigilance or driving.
• Need for specialised diagnostic testing such as polysomnography and multiple sleep latency testing, which are typically performed in sleep specialist services.

Referral should include detailed clinical history, sleepiness assessment scores (e.g., Epworth Sleepiness Scale), comorbidities, and any occupational risks to facilitate prioritisation and rapid assessment by the sleep service.