What are the key clinical features to consider when assessing a patient for obstructive sleep apnea (OSA)?

When assessing a patient for obstructive sleep apnoea/hypopnoea syndrome (OSAHS) in individuals over 16 years, key clinical features from a sleep history and the presence of certain associated conditions should be considered ¹.

• Key Clinical Features from Sleep History

Suspect OSAHS if a patient presents with two or more of the following features from their sleep history ¹:

• Snoring ¹
• Witnessed apnoeas ¹
• Unrefreshing sleep ¹
• Waking headaches ¹
• Unexplained excessive sleepiness, tiredness, or fatigue ¹
• Nocturia (waking from sleep to urinate) ¹
• Choking during sleep ¹
• Sleep fragmentation or insomnia ¹
• Cognitive dysfunction or memory impairment ¹

• Conditions with Higher Prevalence of OSAHS

Be aware that OSAHS has a higher prevalence in people with any of the following conditions ¹:

• Obesity or overweight (including in pregnancy) ¹
• Treatment-resistant hypertension ¹
• Type 2 diabetes ¹
• Cardiac arrhythmia, particularly atrial fibrillation ¹
• Stroke or transient ischaemic attack ¹
• Chronic heart failure ¹
• Moderate or severe asthma ¹
• Polycystic ovary syndrome ¹
• Down's syndrome ¹
• Non-arteritic anterior ischaemic optic neuropathy (sudden loss of vision in one eye due to decreased blood flow to the optic nerve) ¹
• Hypothyroidism ¹
• Acromegaly ¹

• Assessment Scales

For preliminary assessment of sleepiness, the Epworth Sleepiness Scale should be used ¹. Additionally, consider using the STOP-Bang Questionnaire ¹. It is important not to rely solely on the Epworth Sleepiness Scale to determine the need for referral, as not all individuals with OSAHS experience excessive sleepiness ¹.