For General Practitioners

General practitioners are central to identifying and managing obstructive sleep apnoea. This page summarises a practical, evidence-based approach to the workup and management of adult and paediatric OSA in primary care, along with guidance on when and how to refer.

A Primary Care Overview of OSA

Medicine Today Obstructive sleep apnoea in adults and children December 2025

Obstructive sleep apnoea in adults and children – a primary care overview

Kao SS-T, Lathif A, Jones A, Mackay SG.

Medicine Today 2025; 26(12): 12–19.

  • GPs are central to OSA screening, diagnosis and long-term care
  • In adults, diagnosis relies on validated screening tools and a sleep study, with weight loss and lifestyle measures as the foundation
  • PAP therapy is first-line for moderate to severe OSA in adults, with positional devices as useful adjuncts
  • Mandibular advancement splints, fitted by a sleep-trained dentist, are an alternative for selected patients
  • For PAP-intolerant patients, sleep surgery may be an option, tailored to anatomy and OSA severity
  • In children, treating allergic rhinitis, correcting iron and vitamin D deficiency, and adenotonsillectomy when appropriate are the most effective interventions
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Adult OSA: Workup & Management

Presentation Adult with suspected OSA

Snoring, witnessed apnoeas or gasping, unrefreshing sleep, daytime sleepiness, or resistant hypertension

Step 1 · Assess Clarify the main concern
  • Disruptive snoring
  • Excessive daytime sleepiness
  • Long-term health risk
In parallel Exclude other causes of fatigue
  • Hypothyroidism: correct
  • Low iron: supplement
  • Insomnia: CBT-I
  • Mood disorder: psychology or psychiatry
Step 2 · Screen Validated screening tools

Medicare criteria for a sleep study:

  • Epworth Sleepiness Scale (ESS) ≥ 8 AND
  • STOP-Bang ≥ 3 OR
  • OSA50 ≥ 5
Step 3 · Diagnose Sleep study

Refer for polysomnography to confirm the diagnosis and grade severity.

Refer to a sleep physician for excessive sleepiness or commercial drivers.

For snoring · any stage Conservative measures
  • Nasal optimisation: allergy testing, intranasal steroid or combination sprays, allergen minimisation
  • Mandibular advancement splint via a sleep-trained dentist
  • Positional devices or pillows
Result Mild or no OSA

Surveillance, and continue conservative and lifestyle measures.

Result Moderate to severe OSA
  • Lifestyle and weight loss: dietary advice, exercise, GLP-1 or GIP/GLP-1 receptor agonists, bariatric referral
  • PAP trial with a sleep physician: CPAP or auto-PAP with mask optimisation. Adherence is > 5 hours a night on ≥ 5 nights a week
PAP intolerance, refusal or failure
Step 4 · Escalate ENT sleep surgery referral

Upper airway assessment to identify the site of obstruction, and discussion of surgical options to the nose, palate, tonsils, tongue base or jaw, alongside ongoing multidisciplinary care.

Adapted from Kao et al., Medicine Today 2025; 26(12): 12–19. A guide only, and not a substitute for clinical judgement.

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Paediatric OSA: Workup & Management

Presentation Child with snoring or suspected OSA
Step 1 · Assess History and examination

Night: snoring, choking or gasping, witnessed apnoeas, restless sleep, sweating.
Day: poor energy, inattention, behavioural problems.
Examination: tonsil size (grade I–IV), nasal airway, palate.

Primary snoring

Intermittent snoring, no night or day symptoms, tonsils grade I–II

Surveillance · review 6–12 months
Uncertain picture

History and examination don't match, or the family wants a definitive diagnosis

ENT or paediatric sleep physician ± PSG
Sleep-disordered breathing

Night and day symptoms, tonsils grade III–IV

ENT referral
Alongside every pathway
Step 2 · GP optimisation Treat contributing factors
  • Allergic rhinitis: intranasal steroid or combination sprays, allergen avoidance, allergy testing, and immunotherapy in selected cases
  • Restless sleep: check iron studies and vitamin D. Aim for ferritin > 50 µg/L and vitamin D > 75 nmol/L, and recheck at 3 months
  • Poor sleep habits: behavioural strategies, and CBT-I where appropriate
  • High-arched palate: orthodontic review for rapid maxillary expansion, usually around 6–8 years of age
Step 3 · Definitive treatment Adenotonsillectomy

The cornerstone of treatment once nasal and allergic factors are optimised. Around 80% of children improve significantly. The remaining 20% may need further multidisciplinary care, such as further airway surgery, PAP or orthodontics.

Adapted from Kao et al., Medicine Today 2025; 26(12): 12–19. A guide only, and not a substitute for clinical judgement.

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When & How to Refer

Adults

Consider referral for

  • PAP intolerance, poor adherence or refusal
  • Nasal obstruction limiting PAP use or contributing to snoring
  • Disruptive snoring despite conservative measures
  • Patients wanting to explore surgical options
  • Obvious anatomical obstruction, such as large tonsils

Children

Consider referral for

  • Snoring with night or daytime symptoms
  • Tonsils grade III–IV
  • Persistent mouth breathing or nasal obstruction despite medical treatment
  • Incongruent history and examination findings
  • Families seeking a surgical opinion

To help us triage efficiently, please include any sleep study reports, BMI, PAP history and relevant imaging with your referral.

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For healthcare professionals. The information on this page is intended for general clinical guidance and does not replace individual clinical judgement or current guidelines, including the Australasian Sleep Association's recommendations.