Obstructive Sleep Apnea: Clinical Presentation and Differential Diagnosis

Obstructive sleep apnea (OSA) can present with a variety of daytime and nighttime symptoms. Snoring, observed apnea, difficulty breathing, gasping sounds, and excessive sweating are common nighttime symptoms. Mouth breathing, recurrent respiratory infection, daytime fatigue/tiredness, inattention, hyperactivity, and behavior problems are frequent daytime symptoms. Excessive daytime sleepiness is relatively uncommon but is more common in children with severe OSA or obesity. A physical examination can provide useful information, although examination can be normal in children with OSA. Tonsillar hypertrophy, crowed oropharynx, nasal obstruction, and subtle craniofacial abnormalities are relatively common physical findings. Differential diagnosis of OSA can be discussed based on symptomatology and polysomnographic pattern. Clinician should be aware of common presenting symptoms and signs of OSA and the limitation of relying on clinical presentation to make a diagnosis of OSA.