Clinical assessment of obstructive sleep apnoea in adults

In patients with suspected obstructive sleep apnoea, take a history of symptoms and coexisting conditions; ask both the patient and their sleeping partner about symptoms. Symptoms suggestive of obstructive sleep apnoea and common comorbidities are outlined in Symptoms suggestive of obstructive sleep apnoea and common comorbidities.
Figure 1. Symptoms suggestive of obstructive sleep apnoea and common comorbidities.

[NB1]

Symptoms suggestive of obstructive sleep apnoea:

  • snoring—frequency, loudness and whether the partner needs to leave the bedroom
  • waking through the night with a sensation of choking
  • nocturnal interruption of breathing recognised by the partner (‘witnessed apnoeas’)
  • nocturia
  • nocturnal sweating
  • daytime sleepiness and irritability
  • poor concentration or attention span
  • morning headache
  • gastro-oesophageal reflux
  • erectile dysfunction

Common comorbidities:

  • hypertension, more suggestive in younger patients
  • cardiovascular disease, especially atrial fibrillation and heart failure
  • cerebrovascular disease
  • diabetes
  • thyroid disease
  • obesity
  • Down syndrome [NB2]
Note:

NB1: A family history of continuous positive airway pressure (CPAP) use or sleep apnoea increases the likelihood of obstructive sleep apnoea.

NB2: People with Down syndrome are at increased risk of obstructive sleep apnoea, with the prevalence estimated at close to 100% by adulthood. Consider the possibility of obstructive sleep apnoea in all people with Down syndrome, including those without overt symptoms.

The Berlin, STOP-Bang and OSA50 questionnaires can help to identify patients likely to have symptomatic moderate to severe sleep apnoea. Links to these questionnaires can be found on the American Thoracic Society website.

The Epworth Sleepiness Scale can be completed by the patient to give an indication of daytime sleepiness. Patients may deny or be unaware of the severity of their daytime sleepiness; their partner may give a better indication of symptoms. Daytime sleepiness can also be a marker of other conditions, such as depression.

These questionnaires form part of the criteria to access subsidised sleep studies (polysomnograms) through the Medicare Benefits Schedule (MBS). See Diagnosis of obstructive sleep apnoea for more information.