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Sleep Apnoea E017

Last amended 
14 July 2022
Current RMA Instruments
Reasonable Hypothesis SOP
68 of 2022
Balance of Probabilities SOP
69 of 2022
Changes from previous Instruments

SOP Bulletin 231

ICD Coding
  • ICD-10-AM Codes: G47.30, G47.31, G47.32, G47.39

Brief description

This is a sleep disorder characterised by periods of cessation or reduction in airflow in the upper airway, leading to recurrent episodes of arousals and disrupted sleep. This condition can result in excessive daytime sleepiness, impaired memory, difficulty concentrating, morning headaches, high blood pressure, and other cardiac and respiratory complications.

There are three types of sleep apnoea:

  • Central sleep apnoea, where there is repetitive cessation or decrease of both airflow and respiratory effort during sleep (due to diminished or absent central respiratory drive)
  • Obstructive sleep apnoea, where there is repetitive cessation or decrease of airflow during sleep despite respiratory effort
  • Mixed sleep apnoea where central sleep apnoea is followed by an obstructive component
Confirming the diagnosis

This diagnosis will generally require an opinion from a Sleep/Respiratory Physician and will be based on clincial assessment and appropriate investigations, including a sleep study. The type of sleep apnoea needs to be known to apply a number of the SOP factors.

Additional diagnoses covered by SOP
  • Central sleep apnoea
  • Mixed sleep apnoea
  • Obstructive sleep apnoea
  • Upper airway resistance syndrome (a variant of obstructive sleep apnoea)
Conditions excluded from SOP
  • Narcolepsy*
  • Sleep manifestations of a psychiatric disorder
  • Insufficient sleep 
  • Idiopathic hypersomnia#
  • Chronic Insomnia Disorder*
  • Sleep-related hypoventilation disorders#

* another SOP applies- the SOP has the same name unless otherwise specified

# non-SOP condition

Clinical onset

Clinical onset will generally coincide with confirmation of the diagnosis by a sleep/respiratory physician.  This is a threshold diagnosis, based on the number of hypopnoea/apnoea episodes per hour of sleep, so backdating of onset to before a sleep study will generally be difficult.

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.