OSA - Diagnosis

The diagnosis of sleep apnea is a lengthy and involved process. Often times the diagnosis begins at home days, months, or even years before the patient or family consult a physician. A spouse or loved one undoubtedly is the first one to notice the frequent (sometimes constant), loud, and sometimes unbearable snoring at night. Family members are usually the ones to initiate the diagnostic process, as the patient may not even realize that they have a problem, and in fact, may deny snoring at all.

The clinical diagnosis of sleep apnea includes compiling an extensive history as well as a physical exam.

A complete history reveals:

• Heavy snoring at night reported by family, friends, etc.
• Frequent morning headaches due to decreased PaO₂ and increased PaCO₂ resulting from the frequent apneas.
• General feeling of unrestful sleep as the recuperative powers of sleep get interrupted by the frequent apnea periods and subsequent arousals.
• Daytime somnolence
• Frequent daytime naps
• The patient may be a shift worker (working during normal wake hours for the rest of the population) or work rotating shifts

The physical exam reveals:

• Obesity
• Malformations of the jaw
• Tumors or other tissue abnormalities
• Hypertension
• Reduced chest excursion 2^o to obesity.

If both the history and physical exam point to a possible diagnosis of sleep apnea, the physician’s next step is to confirm the diagnosis by ordering a nocturnal polysomnography test. In cases where sleep apnea is already well documented, nocturnal polysomnography allows for the differentiation between central, obstructive, and mixed sleep apneas.

Objectives

Definitions

Cause/Effects

Diagnosis

Polysomnography

Treatments

References

Quiz