Obstructive Sleep Apnea Syndrome Diagnosis
Differential diagnosis <ul><li>Sleep Related Breathing disorder </li></ul><ul><ul><li>A. Respiratory Center  </li></ul></u...
Diagnostic Criteria OSAS <ul><li>1. Loud snoring </li></ul><ul><li>2. Intermittent pause in respiration </li></ul><ul><li>...
Common symptom <ul><li>1. Loud snoring </li></ul><ul><li>2. Excessive daytime sleepiness  </li></ul><ul><li>3. Choking or ...
Less common symptoms <ul><li>1. Morning headache </li></ul><ul><li>2. Enuresis </li></ul><ul><li>3. Reduced libido </li></...
Rare symptoms <ul><li>1. Recurrent arousals/ insomnia </li></ul><ul><li>2. Nocturnal cough  </li></ul><ul><li>3. Symptomat...
Physical signs <ul><ul><li>1. Nasopharyngyeal narrowing </li></ul></ul><ul><ul><li>2. BMI > 28Kg/m2 ; nuchal obesity (M:F:...
Benign snoring <ul><li>Prevalence 20% </li></ul><ul><li>Sex M>F (4:6) </li></ul><ul><li>Age 35-65y </li></ul><ul><li>Predi...
Upper airway resistance syndrome <ul><li>Effort of breathing increased  </li></ul><ul><li>No apnea, hypoxemia </li></ul><u...
Laryngospasm <ul><li>A sudden, prolonged, forceful apposition of the vocal cords </li></ul><ul><li>A laryngeal reflex-resp...
Central sleep apnea syndrome <ul><li>Respiratory center failure in sleep </li></ul><ul><li>Less common then OSAS </li></ul...
Ondine’s curse <ul><li>Central hypoventilation syndrome </li></ul><ul><li>Respiratory center failure during sleep </li></u...
Narcolepsy <ul><li>Excessive daytime sleepiness </li></ul><ul><li>Abnormal REM sleep  </li></ul><ul><li>Sleep paralysis, c...
Periodic leg movements in sleep <ul><li>Insomnia </li></ul><ul><li>Excessive daytime sleepiness </li></ul><ul><li>Frequent...
Restless Leg Syndrome <ul><li>Creeping or crawling sensations in the legs </li></ul><ul><li>An irresistible urge to move t...
Circadian  Rhythm Disorder <ul><li>Common in night shift workers </li></ul><ul><li>A. Delayed sleep phase syndrome </li></...
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Obstructive sleep apnea diagnosis

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Obstructive sleep apnea diagnosis

  1. 1. Obstructive Sleep Apnea Syndrome Diagnosis
  2. 2. Differential diagnosis <ul><li>Sleep Related Breathing disorder </li></ul><ul><ul><li>A. Respiratory Center </li></ul></ul><ul><ul><ul><li>1. Central sleep apnea </li></ul></ul></ul><ul><ul><ul><li>syndrome </li></ul></ul></ul><ul><ul><ul><li>2. Ondine's Curse </li></ul></ul></ul><ul><ul><li>B. Reflex Peripheral </li></ul></ul><ul><ul><ul><li>1. Benign snoring </li></ul></ul></ul><ul><ul><ul><li>2. Airway resistance syndrome </li></ul></ul></ul><ul><ul><ul><li>3. OSAS </li></ul></ul></ul><ul><ul><ul><li>4. Laryngospasm </li></ul></ul></ul><ul><li>Excessive day time sleepiness </li></ul><ul><ul><li>1. Narcolepsy </li></ul></ul><ul><ul><li>2. Periodic leg movements during sleep </li></ul></ul><ul><ul><li>3. Restless leg syndrome </li></ul></ul><ul><ul><li>4. Circadian rhythm disorder </li></ul></ul>
  3. 3. Diagnostic Criteria OSAS <ul><li>1. Loud snoring </li></ul><ul><li>2. Intermittent pause in respiration </li></ul><ul><li>3. Sleep Fragmentation </li></ul><ul><li>4. Excessive daytime sleepiness </li></ul><ul><li>5. Upper airway narrowing </li></ul>
  4. 4. Common symptom <ul><li>1. Loud snoring </li></ul><ul><li>2. Excessive daytime sleepiness </li></ul><ul><li>3. Choking or shortness of breath at night </li></ul><ul><li>4. Restless sleep </li></ul><ul><li>5. Unrefreshing sleep </li></ul><ul><li>6. Changes in personality </li></ul><ul><li>7. Nocturia </li></ul>
  5. 5. Less common symptoms <ul><li>1. Morning headache </li></ul><ul><li>2. Enuresis </li></ul><ul><li>3. Reduced libido </li></ul><ul><li>4. Spouse worried by apnoeic pauses </li></ul><ul><li>5. Nocturnal sweating </li></ul>
  6. 6. Rare symptoms <ul><li>1. Recurrent arousals/ insomnia </li></ul><ul><li>2. Nocturnal cough </li></ul><ul><li>3. Symptomatic oesophageal reflux </li></ul>
  7. 7. Physical signs <ul><ul><li>1. Nasopharyngyeal narrowing </li></ul></ul><ul><ul><li>2. BMI > 28Kg/m2 ; nuchal obesity (M:F:: 17”:16”) </li></ul></ul><ul><ul><li>3. Posterior cross-bite, anterior open-bite and lip-incompetence. </li></ul></ul><ul><ul><li>3. Systemic hypertension </li></ul></ul><ul><ul><li>4. Pulmonary hypertension and corpulmonale (rare) </li></ul></ul>
  8. 8. Benign snoring <ul><li>Prevalence 20% </li></ul><ul><li>Sex M>F (4:6) </li></ul><ul><li>Age 35-65y </li></ul><ul><li>Predisposing factors </li></ul><ul><ul><li>Overweight </li></ul></ul><ul><ul><li>Large tonsils </li></ul></ul><ul><ul><li>Nasal obstruction </li></ul></ul><ul><ul><li>Nasal congestion A small receding chin </li></ul></ul><ul><ul><li>Sleeping on the back Alcohol </li></ul></ul><ul><ul><li>Sleeping tablets </li></ul></ul>
  9. 9. Upper airway resistance syndrome <ul><li>Effort of breathing increased </li></ul><ul><li>No apnea, hypoxemia </li></ul><ul><li>Sleep fragmentation without waking </li></ul><ul><li>Excessive daytime sleepiness </li></ul>
  10. 10. Laryngospasm <ul><li>A sudden, prolonged, forceful apposition of the vocal cords </li></ul><ul><li>A laryngeal reflex-response to noxious stimuli </li></ul><ul><li>Stomach acid and a high airflow rate </li></ul><ul><li>Less than a minute in duration </li></ul>
  11. 11. Central sleep apnea syndrome <ul><li>Respiratory center failure in sleep </li></ul><ul><li>Less common then OSAS </li></ul><ul><li>Associated with Cardiac and Neurological disorder </li></ul><ul><li>Sleep fragmentation and hypoxemia </li></ul><ul><li>Excessive daytime sleepiness </li></ul>
  12. 12. Ondine’s curse <ul><li>Central hypoventilation syndrome </li></ul><ul><li>Respiratory center failure during sleep </li></ul><ul><li>Die immediately after birth without treatment </li></ul>
  13. 13. Narcolepsy <ul><li>Excessive daytime sleepiness </li></ul><ul><li>Abnormal REM sleep </li></ul><ul><li>Sleep paralysis, cataplexy and hypnagogic hallucinations </li></ul><ul><li>Fragmented nighttime sleep with frequent awakenings </li></ul>
  14. 14. Periodic leg movements in sleep <ul><li>Insomnia </li></ul><ul><li>Excessive daytime sleepiness </li></ul><ul><li>Frequent awakenings from sleep, </li></ul><ul><li>Unrefreshing sleep </li></ul>
  15. 15. Restless Leg Syndrome <ul><li>Creeping or crawling sensations in the legs </li></ul><ul><li>An irresistible urge to move the affected extremity </li></ul><ul><li>Relief of the symptoms by walking </li></ul><ul><li>A worsening of the symptoms when the afflicted person is at rest </li></ul>
  16. 16. Circadian Rhythm Disorder <ul><li>Common in night shift workers </li></ul><ul><li>A. Delayed sleep phase syndrome </li></ul><ul><ul><ul><li>Difficulty in falling asleep and getting up </li></ul></ul></ul><ul><li>B. Advance sleep phase syndrome </li></ul><ul><ul><ul><li>Early falling asleep and waking up </li></ul></ul></ul>
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