Sleep apnoea — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 68 of 2022

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting sleep apnoea or death from sleep apnoea with the circumstances of a person's relevant service:

1. (1)
   having heart failure at the time of the clinical onset of sleep apnoea;
2. (2)
   having a central nervous system lesion or disorder from the specified list of central nervous system lesions or disorders at the time of the clinical onset of sleep apnoea;

   Note: specified list of central nervous system lesions or disorders is defined in the Schedule 1 - Dictionary.

3. (3)
   having autonomic neuropathy at the time of the clinical onset of sleep apnoea;

   Note: autonomic neuropathy is defined in the Schedule 1 - Dictionary.

4. (4)
   having chronic renal failure at the time of the clinical onset of sleep apnoea;

   Note: chronic renal failure is defined in the Schedule 1 - Dictionary.

5. (5)
   having a neuromuscular disease affecting the diaphragm, other respiratory muscles or upper airway muscles at the time of the clinical onset of sleep apnoea;

   Note: Examples of a neuromuscular disease affecting the diaphragm, other respiratory muscles or upper airway muscles include myasthenia gravis, postpolio syndrome and motor neurone disease.

   Note: upper airway is defined in the Schedule 1 - Dictionary.

6. (6)
   having acromegaly at the time of the clinical onset of sleep apnoea;

   Note: acromegaly is defined in the Schedule 1 - Dictionary.

7. (7)
   taking an antipsychotic drug for at least the 2 months before the clinical onset of sleep apnoea;
8. (8)
   for obstructive sleep apnoea only: (a) having hypothyroidism, including Hashimoto thyroiditis that has resulted in hypothyroidism, at the time of the clinical onset of obstructive sleep apnoea; (b) having chronic obstruction or chronic narrowing of the upper airway at the time of the clinical onset of obstructive sleep apnoea; (c) being obese at the time of the clinical onset of obstructive sleep apnoea; (d) being in a supine position when sleeping for at least the 6 months before the clinical onset of obstructive sleep apnoea; or (e) taking protease inhibitors as antiretroviral drugs for human immunodeficiency virus infection before the clinical onset of obstructive sleep apnoea;

   Note: upper airway is defined in the Schedule 1 - Dictionary.

   Note: being obese is defined in the Schedule 1 - Dictionary.

   Note: obstructive sleep apnoea is defined in the Schedule 1 - Dictionary.

9. (9)
   for central sleep apnoea only, taking a long-acting opioid at an average daily morphine equivalent dose of at least 75 milligrams for at least the 2 months before the clinical onset of central sleep apnoea;

   Note: central sleep apnoea and long-acting opioid are defined in the Schedule 1 - Dictionary.

10. (10)
    having heart failure at the time of the clinical worsening of sleep apnoea;
11. (11)
    having a central nervous system lesion or disorder from the specified list of central nervous system lesions or disorders at the time of the clinical worsening of sleep apnoea;

    Note: specified list of central nervous system lesions or disorders is defined in the Schedule 1 - Dictionary.

12. (12)
    having autonomic neuropathy at the time of the clinical worsening of sleep apnoea;

    Note: autonomic neuropathy is defined in the Schedule 1 - Dictionary.

13. (13)
    having chronic renal failure at the time of the clinical worsening of sleep apnoea;

    Note: chronic renal failure is defined in the Schedule 1 - Dictionary.

14. (14)
    having a neuromuscular disease affecting the diaphragm, other respiratory muscles or upper airway muscles at the time of the clinical worsening of sleep apnoea;

    Note: Examples of a neuromuscular disease affecting the diaphragm, other respiratory muscles or upper airway muscles include myasthenia gravis, postpolio syndrome and motor neurone disease.

    Note: upper airway is defined in the Schedule 1 - Dictionary.

15. (15)
    having acromegaly at the time of the clinical worsening of sleep apnoea;

    Note: acromegaly is defined in the Schedule 1 - Dictionary.

16. (16)
    consuming an average of at least 30 grams of alcohol per day for at least the 6 months before the clinical worsening of sleep apnoea;

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

17. (17)
    taking an antipsychotic drug for at least the 2 months before the clinical worsening of sleep apnoea;
18. (18)
    for obstructive sleep apnoea only: (a) having hypothyroidism, including Hashimoto thyroiditis that has resulted in hypothyroidism, at the time of the clinical worsening of obstructive sleep apnoea; (b) having chronic obstruction or chronic narrowing of the upper airway at the time of the clinical worsening of obstructive sleep apnoea; (c) being obese at the time of the clinical worsening of obstructive sleep apnoea; (d) being a supine position when sleeping for at least the 6 months before the clinical worsening of obstructive sleep apnoea; or (e) taking protease inhibitors as antiretroviral drugs for human immunodeficiency virus infection before the clinical worsening of obstructive sleep apnoea;

    Note: upper airway is defined in the Schedule 1 - Dictionary.

    Note: being obese is defined in the Schedule 1 - Dictionary.

    Note: obstructive sleep apnoea is defined in the Schedule 1 - Dictionary.

19. (19)
    for central sleep apnoea only, taking a long-acting opioid at an average daily morphine equivalent dose of at least 75 milligrams for at least the 2 months before the clinical worsening of central sleep apnoea;

    Note: central sleep apnoea and long-acting opioid are defined in the Schedule 1 - Dictionary.

20. (20)
    inability to obtain appropriate clinical management for sleep apnoea;

Aggravation-only factors: the factors in subsections 9(10) to 9(20) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.