To fast-track patients that we diagnose with severe sleep apnoea we use the following process:
Patient has a sleep study result with an AHI (Apnoea Hypopnoea Index) >30/hr = severe sleep apnoea
We fax a copy of the results to the referring doctor
We send a copy of the results to the patient asking them to consult with referring doctor (so they are aware and seek treatment)
The patient is added to a list of patients to have an expedited consultation with one of our co-located Sleep Physicians. For this to occur either;
The patient needs to call Peninsula Respiratory Group 9975 4911 to book a consult (Dr KR Burgess, Dr S Braude, Dr K Barclay, Dr L Seeto, Dr P Hullah, Dr S Herath, Dr P Lee) – they just need to state they are on the “severe list” so they can be expedited or
Referring doctor can contact Peninsula Respiratory Group 9975 4911 to book the consult
Treatment is decided with the Sleep Physician and if/when CPAP required, Peninsula Sleep Clinic expedites CPAP trial process and overnight CPAP pressure determination study.
Note: It is a Medicare criterion that CPAP treatment is only referred by a Sleep Physician.
Patient has a sleep study with an Arousal Index >60/hr or a desaturation event <60% SpO2 – these two indicators are linked to sleepiness independently. These patients receive a letter recommending that they do not drive
The reporting Sleep Physician calls the referring doctor to discuss the results directly
Fast tracking process occurs as above for severe results
Note: Peninsula Sleep Clinic does not report any patients to the RMS if they receive a recommendation not to drive.
Peninsula Sleep Clinic (PSC) is dedicated to establishing our patients effectively onto CPAP Therapy and to supporting them with their long-term usage so that they receive all the benefits of CPAP. Our CPAP Clinic has a unique structure where we can provide CPAP Therapist consultations to patients on a one-to-one basis, this gives patients the best opportunity for success when initiating CPAP Therapy. The structure also allows CPAP Therapists direct access to liaise with our patients’ Sleep Physicians and access to the Sleep Clinic’s overnight sleep study data. These data and interactions are invaluable when initiating CPAP Therapy and help us to resolve problems quickly and tailor the care for each individual patient.
Peninsula Sleep Clinic has been developing its processes over the past 28 years. Our data collection on CPAP Usage shows that 86% of our patients are successfully established onto CPAP therapy at the end of their trial. This is much higher than reported usage rates in CPAP Trials at around 42%-46%1 2.
A trial of equipment is essential as CPAP Therapy is not for everyone and every patient has their own response to CPAP Therapy. Symptomatic benefit may not occur in all cases and direct contact the patients’ Sleep Physician helps our CPAP Therapists to resolve any persistent issues that may arise. Whilst CPAP Therapy is the Gold Standard Treatment for Sleep Apnoea sufferers3 it is not always practical and, in these cases, alternate therapies may be required. If a patient does not successfully initiate onto CPAP therapy then they are directed
back to their Sleep Physician to discuss alternative treatments (dental device, weight loss, positional therapy, surgery etc…).
Overview of CPAP Process
Diagnosis sleep apnoea
Sleep Physician consult and referral for CPAP treatment
Mask fitting – one on one at Peninsula Sleep Clinic
Pressure titration study – overnight sleep study to find the correct pressure and determine a suitable mask
Home trial – patient rents equipment for 1-2 months to acclimatise to therapy with multiple appointment and phone calls from our experience CPAP Therapists
Follow up with Sleep Physician
Patient purchases their own equipment for long term use (or is recommended an alternate therapy if CPAP not appropriate)
1 McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, Mediano O, Chen R, Drager LF, Liu Z, Chen G, Du B, McArdle N, Mukherjee S, Tripathi M, Billot L, Li Q, Lorenzi-Filho G, Barbe F, Redline S, Wang J, Arima H, Neal B, White DP, Grunstein RR, Zhong N, Anderson CS, SAVE Investigators and Coordinators. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. N Engl J Med. 2016 Sep;375(10) 919-931. doi:10.1056/nejmoa1606599. PMID:27571048.
2 Kribbs NB, Pack AI, Kline LR, et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. AM Rev Resp Dis 1993;147:887-95.
3 Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine. 2009;5(3):263-276.