EVALUATION

Signs and Symptoms of Snoring & Sleep Apnea

SNORING

Most snorers only complain of a sore throat in the morning or of having tender ribs as a result of being elbowed by their partner. A small percentage of snorers who show no evidence of OSA on sleep monitoring will complain of many of the symptoms of OSA. These individuals seem to be awakened repeatedly during the night by the vibration of the throat tissues themselves.

Snorers come in all shapes and sizes.

OSA

Signs and symptoms of OSA include:

• Excessive daytime sleepiness
• Excessive fatigue
• Irritability
• Anxiousness
• Depression
• Poor memory
• Poor concentration
• Difficulty performing complex tasks
• Loss of sex drive
• Increase in heartburn, especially at night
• Waking up choking or gagging
• Waking up several times a night to go to the bathroom
• Bedwetting in adults
• Waking up with headaches
• Extreme restlessness during sleep
• Abnormal behaviours during sleep such as sleepwalking
• Perspiring heavily while asleep
• Rising blood pressure or poor blood pressure control despite medications
• Palpitations
• Difficulty swallowing due to enlarged throat tissues
• Chronic cough/throat-clearing

None of these symptoms are specific to OSA. However, OSA is the most common cause of excessive daytime sleepiness.

A "typical" patient is an obese, middle-aged male. However, more than 60% of patients with OSA do not fit this profile. The condition is also more common in women than is generally appreciated. Women with OSA have the same symptoms as men with OSA.

Some experts also believe that there is a group of patients, mostly female, who are not loud snorers, who do not show evidence of OSA on sleep monitoring, and yet suffer the symptoms of OSA. This condition is called the Upper Airway Resistance Syndrome (UARS). In these patients, there is partial airway collapse without detectable change in airflow that results in repeated awakenings during sleep. The occurrence of these partial airway collapses can be documented by putting a catheter into the esophagus to measure pressure changes in the chest during breathing. These patients show marked changes in pressure during inspiration that are similar to those seen in patients with OSA. A "typical" patient with UARS is a slender woman in her 20's - 30's with a small jaw and a high, arched palate.

Medical Assessment

Before considering treatment for snoring or OSA, it is important to have a detailed medical assessment. This assessment consists of:

• A Medical History
  • Risk factors for OSA such as:
    • obesity
    • smoking
    • alcoholism
    • nasal allergies
    • family history of OSA
    • race
  • Sleep habits
    • irregular sleep-wake schedule
    • shift work
  • Medical conditions such as
    • hypertension
    • angina
    • stroke
    • irregular heart rhythms
    • adult-onset diabetes
  • Occupation
    • truck driving
  • Medications
    • sedatives
  • Previous treatments for snoring or OSA
  • Family history of medical conditions other than OSA
• A Physical examination
  • height and weight
  • neck circumference
  • oral cavity
  • general examination with special emphasis on the cardiovascular and pulmonary systems
• A Dynamic nasopharyngoscopy
• The Epworth Sleepiness Scale
• A Calculated probability of having OSA
• The Stanford Method for Predicting OSA

Depending on the findings to this point, a patient may be recommended to have a sleep study to determine whether he/she has OSA as a part of his/her snoring problem.

Note: OSA is a clinical diagnosis. A sleep study is performed for the purpose of:

• confirming the diagnosis (particularly for securing extended health coverage),
• grading the severity (which is helpful in determining if CPAP or a dental appliance is the best treatment for the patient who has borderline findings on dynamic nasopharyngoscopy).

The choice of treatment depends critically on the findings of the medical assessment. Once treatment is started for a patient who has OSA, close medical follow-up is required to insure that the patient has the best possible result from their treatment.