Sleep Clinic Referral Checklist
Use this checklist to guide referrals for patients with suspected complex sleep-disordered breathing or non-respiratory sleep conditions (e.g. narcolepsy, RBD, idiopathic hypersomnia). It supports efficient triage and multidisciplinary assessment.
Important: Always assess fitness to drive in patients with excessive sleepiness or diagnosed sleep disorders.
Confirm Referral Criteria:
1. Suspected complex sleep-disordered breathing:
- Patients with unclear obstructive sleep apnoea (OSA) or obesity hypoventilation syndrome (OHS) phenotypes, especially when symptoms are disproportionate to findings.
- Individuals who are intolerant of CPAP, or have failed standard CPAP therapy despite good adherence.
- Cases of positional or mild OSA with significant daytime symptoms or comorbidities.
2. Suspected non-respiratory sleep disorder:
- Symptoms suggestive of narcolepsy (e.g. sleep attacks, cataplexy, hallucinations, sleep paralysis).
- Idiopathic hypersomnia with no clear respiratory cause.
3. REM sleep behaviour disorder (RBD):
- Vivid dream enactment behaviour, shouting or violent movements in sleep.
4. Complex or atypical parasomnias or nocturnal events (e.g. nocturnal seizures vs NREM parasomnias).
5. Suspected neurological sleep disorder:
- Sleep disturbance in the context of Parkinson’s disease, Lewy body dementia, or autonomic dysfunction.
- Sleepiness or disrupted sleep in patients with early cognitive changes or neurodegenerative suspicion.
6. Diagnostic uncertainty:
- When initial WatchPAT results do not explain clinical presentation.
- Where complex comorbidities suggest overlapping sleep and neurological disorders.
Attachments to Include
• Recent clinic letter that clearly outlines the referral question and summary of the clinical problem.
• A completed Epworth Sleepiness Scale (ESS) for assessing daytime sleepiness.
• STOP-BANG score or alternative screening for OSA (if applicable).
• Sleep study reports (if had previously): WatchPAT, or PSG results, even if normal.
• Any relevant neurology or psychiatry correspondence, especially if parasomnia or hypersomnolence is suspected.
• Full medications list, especially for drugs affecting sleep (e.g. antidepressants, dopaminergic agents, hypnotics).
. Consider Screening for Neurodegeneration
• Does the patient describe vivid dreams or dream enactment (suspicious for RBD)?
• Are there signs of hyposmia, constipation, or orthostatic symptoms?
• Is there excessive daytime sleepiness combined with fragmented nocturnal sleep?
• Are there subtle or overt Parkinsonian features, or a family history of neurodegeneration?
Optional Supporting Investigations (liaise with Neurology accordingly)
• MRI Brain to exclude structural or neurodegenerative changes when indicated.
• DaTscan if RBD with Parkinsonian features or subtle motor signs are present