Clinical Evaluation of the Obstructive Sleep Apnea Patient

Most patients with obstructive sleep apnea present to clinical attention with symptoms of excessive daytime sleepiness or poor quality sleep. A detailed history and physical examination is helpful in assessing patient risk for obstructive sleep apnea and if they require further testing for confirmation of the diagnosis. The clinical evaluation must include inquiring about common obstructive sleep apnea symptoms such as snoring, witnessed apneas, and daytime sleepiness as well as key features of other sleep disorders that can cause sleepiness. It is helpful to inquire about other medical conditions that put the patient at risk for obstructive sleep apnea. A detailed oropharyngeal, cardiopulmonary, and neurological physical examination can further assist in assessing risk of obstructive sleep apnea. The history and physical examination may also be helpful in determining other possible causes of their sleep complaints such as restless legs syndrome, insomnia, or narcolepsy. Objective testing for obstructive sleep apnea with either home sleep apnea testing or in lab polysomnography is most helpful and appropriate in patients who have been properly identified to be at high risk for obstructive sleep apnea or sleep-disordered breathing by history and physical examination.