Sleep-Disordered Breathing and CPAP Clinical Presentation

Updated: Mar 02, 2022
  • Author: Vittorio Rinaldi, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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The first clue in the history of patients with sleep-disordered breathing (SDB) is loud snoring. This is accompanied by breathing cessation; gasping, choking, and snorting; frequent arousals from sleep; and respiratory effort with no air. Nocturnal arrhythmias and acute blood pressure increases may occur. Morning headaches that dissipate as the day goes on, excessive daytime sleepiness, and poor concentration affect daytime performance. The disorder has been linked to an increased risk of angina, myocardial ischemia, stroke and motor vehicle accidents.

Older men may report getting up numerous times during the night to urinate and are convinced that they awaken because of the urge to urinate. The truth is often the reverse—namely, that they first awaken as a result of SDB and only then notice the urge to urinate. These patients are often surprised at their decreased need for nocturnal urination after successful SDB treatment.

Laryngopharyngeal reflux can cause a patient to suddenly awaken from sleep, gasping for breath. A feeling of terror is often present.

Inadequate sleep time can cause excessive daytime sleepiness. This may be involuntary, as in insomnia, or voluntary. Insomnia is characterized by the inability to fall asleep or awakening during the night and being unable to fall back to sleep. Inadequate sleep time occurs for other voluntary reasons (eg, working more than one job, family responsibilities).

Patients with hypothyroidism can also present with fatigue, daytime somnolence, and obesity. SDB and hypothyroidism can coexist. [41]

Narcolepsy can also cause excessive daytime sleepiness.


Physical Examination

Most patients with SDB are overweight or obese. A patient with a short, thick neck may be predisposed to SDB. Scalloped indentations along the lateral tongue (from teeth) are a marker for relative tongue/mandibular arch size mismatch, which may predispose individuals to SDB.

Children with obstructive sleep apnea (OSA) syndrome (OSAS) are likely to present with normal body weight, tonsillar hypertrophy, and inattentiveness during school classes. [42]  However, OSAS in children is not discussed in this article.



If not adequately diagnosed and treated, OSAS is associated with severe complications such as hypertension, strokes, coronary disease, and neurobehavioral complaints and is probably a predictor of premature death. At least 50% of patients with heart failure have sleep respiratory apneas, and patients with moderate-to-severe OSAS have a threefold higher risk of developing hypertension. [21, 22, 23, 24, 25]