Clinical Features of Sleep Apnea

Clinical Features of Sleep Apnea

• Daytime sleepiness: Characterized by excessive drowsiness and difficulty staying awake while engaged in activities.
• Weight gain: Obesity is a common risk factor for obstructive sleep apnea (OSA).
• Snoring or gasping: Loud snoring and episodes of gasping or choking during sleep are hallmark signs of OSA.
• Nocturnal dyspnea: Difficulty breathing during sleep, possibly due to conditions like paroxysmal nocturnal dyspnea (PND), nocturnal asthma, or gastroesophageal reflux disease (GERD).
• Frequent awakenings at night: Restlessness, tossing and turning, and frequent awakenings throughout the night are common due to disrupted sleep patterns.
• Involuntary dozing: Falling asleep unintentionally during activities such as driving or working.
• Dry mouth, halitosis (bad breath), and mood swings: These symptoms can occur as a result of mouth breathing during sleep.
• Erectile dysfunction: OSA can lead to decreased testosterone levels and blood flow to the penis, contributing to erectile dysfunction.

Examination Findings in Sleep Apnea

• Elevated blood pressure (BP): High blood pressure can be either pre-existing or a consequence of OSA.
• Increased abdominal girth: Obesity and increased abdominal fat are associated with OSA.
• Increased neck circumference: A larger neck circumference can contribute to airway obstruction during sleep.
• Enlarged tongue: A larger than average tongue can contribute to airway blockage.
• Smaller or misaligned mandible: A lower-positioned palate can narrow the airway.
• Bulky uvula: A large uvula can partially block the airway passage.
• Enlarged tonsils: Enlarged tonsils can contribute to adenotonsillar hypertrophy, particularly in children, further hindering airflow.

Workup for Sleep Apnea

• Polysomnography (PSG or IOC): A comprehensive sleep study to diagnose and assess the severity of OSA.
  • Electrodes around the eye (EOG): Measure eye movements, indicating different sleep stages.
  • Electrodes on the chin (EMG): Monitor muscle activity, reflecting sleep patterns.
  • Electrocardiogram (ECG): Records heart rhythm and electrical activity.
  • SpO2 (oxygen saturation) monitoring: Measures blood oxygen levels, revealing potential episodes of oxygen desaturation during sleep.
  • Nasal airflow monitoring: Tracks airflow in and out of the nose, identifying any respiratory disturbances.
  • Chest and abdominal movements: Monitors breathing movements during sleep, detecting abnormalities.
  • Examination for paradoxical breathing during sleep: Identifies any unusual or ineffective breathing patterns during sleep.
• Blood Pressure (BP) Monitoring: Monitors blood pressure fluctuations throughout the night, looking for the absence of a normal nocturnal dip in BP, which can be an early indicator of OSA.
• Echocardiogram (Echo):
  • Chamber size: To determine the size of the heart chambers, specifically to check for left ventricular hypertrophy (LVH) which is present but right ventricular hypertrophy (RVF) is not observed.

Explore the key clinical features associated with sleep apnea, including signs like excessive daytime sleepiness, snoring, and nocturnal breathing difficulties. This quiz will help you understand the impact of sleep apnea on health and well-being, along with its common symptoms. Test your knowledge on this important sleep disorder.