Obstructive sleep apnoea or sleep disordered breathing in paediatric patients

​​​​​​​​​​​​​​​​​​​Emergency

If any of the following are suspected, please seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary):

  • Breathing difficulties while awake
  • Confirmed hypoxia while awake
  • Rapid progression of symptoms with significant concerns expressed by the parent or referring health professional
  • Witnessed cyanosis with recurrent or prolonged apnoea especially in infants

When public outpatient services are not routinely provided

  • Infants with settling issues or children with primarily behavioural sleep concerns

Note: consider general paediatrician for sleep concerns or a psychologist for behavioural concerns

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days
  • Aged < 12 months with significant concern about noisy breathing with recurrent or prolonged apnoeas, colour change and/or increased work of breathing during sleep
  • Diagnosis of a severe and life-limiting disorder with known likely sleep disordered breathing (e.g. untreated spinal muscular atrophy or other neuromuscular conditions) where sleep intervention would be considered
  • Infant with significant desaturations and a cleft palate or craniofacial abnormalities
  • Prior to commencing growth hormone in the setting of Prader-Willi Syndrome
  • Significant sleep related hypoxia or hypercarbia in the absence of an acute illness demonstrated using appropriate equipment
Category 2
Recommended to be seen within 90 calendar days
  • Recurrent snoring with associated symptoms (e.g. apnoeas, and/or arousal during sleep, restless sleep, mouth breathing, daytime tiredness or headaches on waking, poor concentration requiring objective evaluation) for confirmation of obstructive sleep apnoea
  • Recurrent snoring (i.e. > 3 days per week) with risk factors for obstructive sleep apnoea (e.g. obesity, hypotonia, facial dysmorphology, specific syndromes such as Trisomy 21)
  • Transfer of care from one healthcare facility to another for a child on respiratory support
  • Worsening symptoms or ongoing concerns after ENT surgical interventions for sleep disordered breathing
    Note: recommended to be seen by ENT specialist initially prior to referral to sleep physician if worsening of symptoms after ENT surgical intervention
​Category 3
Recommended to be seen within 365 calendar days		​
  • On respiratory support (including oxygen)
    Note: should be seen within 6 months
  • Persistent symptoms of obstructive sleep disordered breathing following trial of nasal steroids for ≥ 4 weeks
    Note: should be seen within 6 months
  • Suspected sleep disordered breathing and underlying developmental or behavioural issues
    Note: should be seen within 6 months
  • Snoring and/or significant sleep fragmentation and sleep related behavioural concerns
    Note: should be seen within 6-months
  • Suspected sleep disordered breathing and persistent bed wetting (enuresis)
    Note: should be seen within 6 months
  • Suspected sleep disordered breathing and tooth grinding (bruxism) following dental review and exclusion of other causes
    Note: should be seen within 6 months
          

Information to include within a referral

Required

  • Reason for referral
  • Details of the presenting condition, including symptoms and their duration, and impact on activities of daily living and school attendance
  • Provisional diagnosis
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • Assessment of relevant contributory factors (such as psychosocial and environmental contributors)
    • History of prematurity
    • Patient or growth parameters
    • Physical examination (especially presence of tonsil hypertrophy, or mouth breathing or other relevant oropharyngeal features)
    • Presence of a co-existing condition that predisposes them to sleep disordered breathing (e.g. craniofacial abnormality, cleft palate, neuromuscular conditions,
      Down syndrome, Prader-Willi Syndrome)
    • Previous ENT review outcome or intervention
    • Previous sleep study results
    • Respiratory related hospital admissions within the last 6-12 months
    • Tonsillar hypertrophy grading scale (Brodsky scale)

If available

  • Details of any gas exchange monitoring undertaken (including overnight oximetry, overnight transcutaneous CO2 monitoring, early morning blood gas results)
  • If on respiratory support, provide any available information on adherence
  • Imaging results
  • Lung function test results
  • Outcome of use of trial of nasal corticosteroids consistently for at least 4 weeks and effect on sleep symptoms
  • Paediatric Epworth or Paediatric Daytime Sleepiness Scale (PDSS)
  • Previous polysomnography (PSG) report
  • Response to any other treatment interventions such as montelukast, nasal saline or inhaled therapies
  • Total OSA-18 score
  • Video evidence of child with sleep disordered breathing

 

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

​

Additional paediatric sleep medicine conditions

Current as at: Thursday 10 September 2026
Contact page owner: System Purchasing