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Obstructive Sleep Apnea Syndrome
Diagnosis
OSAS Diagnosis
Differential diagnosis Sleep Related
Breathing disorderA. Respiratory Center
1. Central sleep apnea syndrome2. Ondine's Curse
B. Reflex Peripheral
1. Benign snoring2. Airway resistance
syndrome3. OSAS4. Laryngospasm
Excessive day time sleepiness 1. Narcolepsy
2. Periodic leg movements during sleep
3. Restless leg syndrome
4. Circadian rhythm disorder
OSAS Diagnosis
Diagnostic Criteria OSAS
1. Loud snoring
2. Intermittent pause in respiration
3. Sleep Fragmentation
4. Excessive daytime sleepiness
5. Upper airway narrowing
OSAS Diagnosis
Common symptom1. Loud snoring2. Excessive daytime sleepiness 3. Choking or shortness of breath at
night 4. Restless sleep 5. Unrefreshing sleep 6. Changes in personality7. Nocturia
OSAS Diagnosis
Less common symptoms
1. Morning headache
2. Enuresis
3. Reduced libido
4. Spouse worried by apnoeic pauses
5. Nocturnal sweating
OSAS Diagnosis
Rare symptoms
1. Recurrent arousals/ insomnia
2. Nocturnal cough
3. Symptomatic oesophageal reflux
OSAS Diagnosis
Physical signs1. Nasopharyngyeal narrowing
2. BMI > 28Kg/m2 ; nuchal obesity (M:F:: 17”:16”)
3. Posterior cross-bite, anterior open-bite and lip-incompetence.
3. Systemic hypertension
4. Pulmonary hypertension and corpulmonale (rare)
OSAS Diagnosis
Benign snoring
• Prevalence 20%
• Sex M>F (4:6)
• Age 35-65y
• Predisposing factors– Overweight – Large tonsils – Nasal obstruction – Nasal congestion A small
receding chin – Sleeping on the back
Alcohol– Sleeping tablets
OSAS Diagnosis
Upper airway resistance syndrome
• Effort of breathing increased
• No apnea, hypoxemia
• Sleep fragmentation without waking
• Excessive daytime sleepiness
OSAS Diagnosis
Laryngospasm
• A sudden, prolonged, forceful apposition of the vocal cords
• A laryngeal reflex-response to noxious stimuli
• Stomach acid and a high airflow rate
• Less than a minute in duration
OSAS Diagnosis
Central sleep apnea syndrome
• Respiratory center failure in sleep
• Less common then OSAS
• Associated with Cardiac and Neurological disorder
• Sleep fragmentation and hypoxemia• Excessive daytime sleepiness
OSAS Diagnosis
Ondine’s curse
• Central hypoventilation syndrome
• Respiratory center failure during sleep
• Die immediately after birth without
treatment
OSAS Diagnosis
Narcolepsy
• Excessive daytime sleepiness
• Abnormal REM sleep
• Sleep paralysis, cataplexy and hypnagogic hallucinations
• Fragmented nighttime sleep with frequent awakenings
OSAS Diagnosis
Periodic leg movements in sleep
• Insomnia
• Excessive daytime sleepiness
• Frequent awakenings from sleep,
• Unrefreshing sleep
OSAS Diagnosis
Restless Leg Syndrome
• Creeping or crawling sensations in the legs
• An irresistible urge to move the affected extremity
• Relief of the symptoms by walking• A worsening of the symptoms when
the afflicted person is at rest
OSAS Diagnosis
Circadian Rhythm Disorder
Common in night shift workers
A. Delayed sleep phase syndromeDifficulty in falling asleep and getting up
B. Advance sleep phase syndromeEarly falling asleep and waking up
