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Sleep Apnoea E017

Document
Last amended 
27 January 2016
Current RMA Instruments:
Reasonable Hypothesis SOP
41 of 2013
Balance of Probabilities SOP
42 of 2013
Changes from previous Instruments:

SOP Bulletin 166

ICD Coding:
  • ICD-9-CM Codes: 780.51,780.53,780.57
  • ICD-10-AM Codes: G47.30, G47.31, G47.32, G47.33, G47.39

Brief description

This is a disorder of breathing during sleep, with periods of cessation or reduction of airflow.  There are three types of sleep apnoea:

  • Central sleep apnoea, where there is a transient loss of neural drive to the respiratory muscles
  • Obstructive sleep apnoea, where airflow ceases due to occlusion of the oropharyngeal airway
  • Mixed sleep apnoea where central sleep apnoea is followed by an obstructive component
Confirming the diagnosis

This diagnosis is based on a formal sleep study with a report on the study provided by a sleep / respiratory physician.  The SOP definition also requires that there be clinical consequences from sleep disordered breathing, such as: excessive daytime sleepiness; impaired memory; difficulty concentrating; morning headaches; pulmonary hypertension; right heart failure; or respiratory failure. If none of these features is present, the sleep apnoea is not clinically significant and should be regarded as N.I.F. (No Incapacity Found). The type of sleep apnoea needs to be known to apply a number of the SOP factors.

Periods of cessation of breathing (apnoea) during sleep are a normal occurrence in many healthy individuals.  They only become significant (a disease) when of sufficient frequency and duration to cause physiological and clinical consequences. Whilst most snorers do not have obstructive sleep apnoea, snoring accompanies narrowing of the upper airways which occurs during sleep and predisposes to obstructive sleep apnoea.

Additional diagnoses covered by SOP
  • Central sleep apnoea
  • Mixed sleep apnoea
  • Obstructive sleep apnoea
Conditions excluded from SOP
  • Narcolepsy (ICD-9 347; ICD-10 G47.4)
  • Sleep apnoea not accompanied by clinical consequences
  • Sleep manifestations of a psychiatric disorder
  • Transient sleep apnoea
Clinical onset

For this condition, given the diagnostic requirement of at least five apnoea or hypopnoea episodes per hour of sleep (as confirmed by a sleep study), clinical onset generally will coincide with confirmation of diagnosis.

Clinical worsening

Clinical worsening may be evidenced by an increase in the number or duration of apnoea or hypopnoea episodes or in the severity of associated clinical consequences.  The development of related health consequences such as cardiovascular diseases does not represent a worsening of the sleep apnoea per se.  The condition is amenable and responsive to treatment, including lifestyle measures (e.g. weight loss) and continuous positive airway pressure therapy.