Good Guidance
I’m a big fan of the Scottish Intercollegiate Guidelines Network (SIGN) guidelines, especially the quick reference guides.
This one on obstructive sleep apnoea is a PDF that can be printed on two sides of A4 and folded into a neat leaflet.
The recommendations are graded A, B, C, or D according to the strength of the supporting evidence. And although it is so brief, all the basics are here.
The diagnosis section covers history, physical examination and diagnostic tools, which include polysomnography, limited sleep studies and oximetry.
Under treatment come behavioural interventions, non-surgical interventions, and a statement that pharmacological therapy should not be used as first-line therapy. Surgical interventions are also dealt with, and there is an interesting section on quality of life, driving and the DVLA’s recommendations for affected patients.
There are other little gems in this short item, such as that sleep apnoea must be excluded before surgical treatment for snoring, and that the combination of COPD and sleep apnoea is potentially dangerous.
Why go there: concise, good quality information.
Downside: none.
Information from: SIGN guidelines.
Address: www.sign.ac.uk/pdf/qrg73.pdf
Using the Epworth sleepiness score
This site on the ESS chart is necessary because the downside to a print-off chart is that it contains minimal information on how to interpret the results. This one-page PDF fact sheet explains them in full.
The ESS was originally developed by Murray Johns, MD, of the Epworth Hospital in Melbourne, Australia, in 1991. I hope he receives some sort of commission for its use.
In the site you find an overview of how the scale works, and a paragraph about how you should read the results. This tells you that a score of 5.9 is about normal, and untreated sleep apnoea scores about 16. If your patient scores over 17.5, they probably have narcolepsy.
The maximum score is 24. If you obtain this result, I suggest you look for signs of rigor mortis — or maybe it’s someone who has just read one of GP’s rival publications.
Why go there: a simple method of interpretation.
Downside: none.
Information from: Cephalon.com.
Address: www.cephalon.com/newsroom/factsheets/ESS_Fact_Sheet.pdf#search=%22Epworth%20sleepiness%20score%22
Dr Barnard is a former GP in Fareham, Hampshire
Website of the week
I do not often pick a patient site as website of the week, but this PDF from down under deserves the accolade by being so easy to read and containing just the right amount of detail. Its headline suggests it is aimed at drivers, but it is equally relevant for anyone who may have the condition.
Each section is brief, clear and has an illustration, and ends by giving the patient a guide to treatment options. There is also a paragraph about what it is like to use a continuous positive pressure airways machine.
The information is good enough to remind GPs of the essentials. Directing sufferers to the site, or offering them a print-out of the PDF, will undoubtedly result in a saving of consultation time and a better-informed patient.
Why go there: excellent patient information.
Downside: no Epworth sleepiness scale.
Information from: Australian Lung Foundation.
Address: www.ntc.gov.au/filemedia/Publications/DYHFSSup2aObstSleepApnoeaMar2005.pdf
