History

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.

Complications

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]}

Differential Diagnoses

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Media Gallery

CPAP machine.

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Author

Vittorio Rinaldi, MD Specialist in Otolaryngology, Division of Otolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Fondazione I.R.C.C.S. Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy

Disclosure: Nothing to disclose.

Coauthor(s)

Andrea Costantino, MS Campus Bio-Medico University of Rome, Italy

Disclosure: Nothing to disclose.

Alberto Luchena Campus Bio-Medico University of Rome, Italy

Disclosure: Nothing to disclose.

Lorenzo Sabatino, MD Resident Physician, Unit of Otolaryngology, Campus Bio-Medico University of Rome, Italy

Disclosure: Nothing to disclose.

Manuele Casale, MD Specialist in Otolaryngology, Campus Bio-Medico, University of Rome School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert M Kellman, MD Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Jack A Coleman, MD Consulting Staff, Franklin Surgical Associates

Jack A Coleman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Sleep Medicine, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, The Triological Society, American Society for Laser Medicine and Surgery, The Society of Federal Health Professionals (AMSUS)

Disclosure: Received honoraria from Accarent, Inc. for speaking and teaching.

Fabrizio Salvinelli, MD Professor of Otolaryngology, Campus Bio-Medico, University of Rome

Disclosure: Nothing to disclose.

Francesco Faiella, MD Resident in Otolaryngology, Campus Bio-Medico University of Rome School of Medicine

Disclosure: Nothing to disclose.

Marco Pappacena, MD Resident, Department of Otolaryngology, Campus Bio-Medico University, Rome

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Karen Hall Calhoun, MD, to the development and writing of the source article

The first author, Vittorio Rinaldi, gratefully thanks Prof P.G.Visvanathan for having introduced him to snoring and OSA surgical management.