Sleep Disorders
Factors considered in assessing the risk of a sleep disorder include:
evidence or indicators of excessive daytime sleepiness (including the Epworth Sleepiness Scale (ESS) score (question 4 of the Safety Critical Worker Health Questionnaire, or work performance report indicating excessive sleepiness);
clinical evidence of Obstructive Sleep Apnoea (loud snoring, witnessed apnoea events); or
clinical risk factors that warrant further investigation:
body mass index (BMI) equal to or greater than 40 or a BMI of equal to or
BMI greater than 35 if associated with type 2 diabetes or with high blood pressure requiring two or more medications for control.
There are different tests that can assist with diagnosing Obstructive Sleep Apnoea (OSA).
Home sleep study – can be arranged via a chemist.
Sleep Laboratory – requires a referral from your GP to a Sleep Specialist.
If OSA is diagnosed, the ongoing requirement to provide a report will depend on the severity of OSA.
If the diagnostic sleep study reveals severe OSA requiring CPAP treatment, you will be required to:
Provide periodic CPAP usage reports.
Provide an initial Sleep Specialist report to inform the Chief Medical Officer’s assessment of your fitness to perform safety critical activities.
Attend your Sleep Specialist on annual basis and provide a report to KINNECT; the Chief Medical Officer may determine that the annual report can be provided by your treating general practitioner (GP) if there is an established pattern of compliance with treatment and treatment is effective, and if your GP has a shared care arrangement with your Sleep Specialist.
If your diagnostic sleep study reveals mild or moderate OSA, you will be provided with a Duty of Care letter to take to your Treating GP for consideration of further treatment.
The letter requesting a medical report from KINNECT explains:
When the report must be provided back to KINNECT – at least 2 weeks prior to the current certificate expiring.
Exactly what we are asking the GP to organize
A copy of the relevant section from the National Standard
CPAP usage report
If you have been diagnosed with OSA and are using a CPAP machine you may be asked for a report to confirm satisfactory use (for at least 4 hours per sleep session) and effectiveness of treatment.
Some machines will allow for the download of a report while others should be obtained from the specialist technician.
Body Mass Index (BMI)
The National Standard requires that BMI is used in various calculations including the risk assessment of sleep disorders and cardiac risk score/level:
2.2.6. Biometrics / sleep
Height and weight are measured to BMI as part of the sleep disorder risk assessment (refer to BMI nomogram in Section 18.6. Sleep disorders). Blood pressure requiring treatment and diabetes are also considered in assessing the risk of sleep disorders.
12.3.2. Cardiac Risk Score/level
In borderline cases, family history or elevated BMI may be considered when determining the need for further assessment such as a stress ECG, and fitness classification. The worker may need to be immediately classed Temporarily Unfit for Duty pending further assessment. Workers with raised risk levels require a stress ECG.
