Reducing waiting times for sleep apnoea hypopnoea syndrome and snoring using a questionnaire and home oximetry: results of a second audit cycle

As a result of a previous audit on the management of sleep apnoea hypopnoea syndrome (SAHS) which showed long waiting times that were primarily due to unnecessary interspecialty referrals, a change in practice was adopted. Al l referrals are now sent a questionnaire about symptoms suggestive of SAHS, the Epworth Sleepiness Scale score and their body mass index (BMI) which w hen returned are categorized into having a high, intermediate or low risk o f SAHS. Those patients with a high probability have home overnight oximetry and those with intermediate probability have video oximetry. Those with a low probability are referred directly to ENT. We audited the first 100 pati ents referred. All were General Practitioner referrals to either ENT or res piratory medicine. Only two patients had a low probability score and were s een directly in ENT. Following sleep study analysis, 10 patients were refer red directly to ENT with no respiratory medicine follow-up and nine were di scharged back to the General Practitioner with no apnoea or snoring. Eighty -one patients were followed up by respiratory medicine. Of these, 49 receiv ed a trial of nasal continuous positive airway pressure (nCPAP) and six wer e referred to ENT. Therefore the majority justified an investigation to exc lude SAHS in the first instance and an unnecessary initial ENT appointment was avoided. We have reduced the average waiting times to sleep study by ap proximately 90 days and to nCPAP trial by 32 days, mostly due to decreased delays in interspecialty referrals. We have also demonstrated a greater tha n 50 per cent reduction in ENT clinic visits, a small increase in the numbe r of sleep studies but no increase in respiratory clinic workload.