Sleep disordered breathing / obstructive sleep apnoea – Paediatric
Sleep disordered breathing / obstructive sleep apnoea – Paediatric
| This RAC is applicable to referrals for patients aged <16 years only. Please refer to the Adult ENT RAC for referrals for patients aged 16 years or more. |
Emergency and immediate referrals
Referral to Emergency Department
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:
- Acutely enlarging neck mass with any associated airway symptoms e.g. stridor, drooling, dysphagia etc
- Abscess or haematoma (e.g. peritonsillar, parapharyngeal (quinsy), salivary, neck or retropharyngeal abscess)
- Airway compromise: severe stridor/drooling/ breathing difficulty/acute, sudden voice change/severe odynophagia
- Foreign body (button batteries – inhaled or ingested) if suspicion of button battery immediate emergency review
- Hoarseness associated with neck trauma or surgery
- If new onset hoarse voice and any airway obstructive symptoms
- Post-tonsillectomy haemorrhage
- Trauma
Immediately contact on-call registrar or service to arrange an immediate ENT assessment (seen within 7 days) for:
- Clinical concern regarding prolonged apnoeas, cyanosis, altered level of consciousness or significant and escalating parental concerns should prompt direct phone contact with the ENT registrar on call to discuss the case and arrange review as clinically appropriate
To contact the relevant service, please see HealthPathways: Acute Paediatric ENT Assessment
| Presenting issues |
- Sleep disordered breathing/obstructive sleep apnoea
|
| Mandatory referral information (referral will be returned if this information is not included) |
|
History
- Relevant history and description of sleep disordered breathing/obstructive sleep apnoea
Examination
- Tonsillar hypertrophy grading scale (Brodsky scale)
- Total OSA-5 score calculated as per the table below:
| During the past 4 weeks, how often has the child had… |
None of the time |
Some of the time |
Most of the time |
All of the time |
| 1. Loud snoring |
0 |
1 |
2 |
3 |
| 2. Breath holding spells or pauses in breathing at night? |
0 |
1 |
2 |
3 |
| 3. Choking or made gasping sounds while asleep? |
0 |
1 |
2 |
3 |
| 4. Mouth breathing because of a blocked nose? |
0 |
1 |
2 |
3 |
| 5. Breathing problems during sleep that made you worried that they were not getting enough air? |
0 |
1 |
2 |
3 |
If unable to attach reports, please include relevant information/findings in the body of the referral
Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)
|
| Highly desirable referral information |
- Obstructive sleep apnoea with co-existing craniofacial abnormality
- Paediatric Epworth/pictorial Sleepiness Scale
- Recent paediatric polysomnography
|
Indicative triage category
| Indicative triage category |
Category 1
Appointment within 30 days |
- No defined category 1 criteria
|
Category 2
Appointment within 90 days |
- Severe obstructive sleep apnoea
- Obstructive sleep apnoea with faltering growth (failure to thrive)
|
Category 3
Appointment within 365 days |
- Sleep disordered breathing/obstructive sleep apnoea
- Upper airway obstruction due to adenoid or tonsil hypertrophy
- Nasal obstruction and snoring
|
Useful information for referring practitioners
- The Brodsky Scale assists in gauging the severity of tonsil enlargement. The Brodsky Scale encompasses:
- Grade 0 - tonsils within tonsillar fossa/removed
- Grade 1 - tonsils just outside tonsillar fossa and occupy <25% of the oropharyngeal width
- Grade 2 - tonsils occupy between 26% and 50% of the oropharyngeal width
- Grade 3 - tonsils occupy between 51% and 75% of the oropharyngeal width
- Grade 4 - tonsils occupy >75% of oropharyngeal width
Last reviewed: 04-10-2023