To detect the possible presence of OSA, the physician should incorporate sleep related questions into the history- taking process, and be aware of signs of the disease during the physical exam.

The three main symptoms of obstructive sleep apnea are the following:

1.Chronic, loud snoring. Sleep apnea is unlikely if it can be confirmed that the patient does not snore. Since very few people are aware that they snore or stop breathing in sleep unless they are told, it is often important to obtain a history from the bed partner or other family members.

2. Gasping or choking episodes during sleep.

Again, reports from bed partners or family members will likely be needed to obtain accurate information about snoring and apneic events.

3. Excessive daytime sleepiness (EDS). The predictive power of these key symptoms is subject to controversy. When combined with hypertension, body mass index, and age they form a sensitive predictor of OSA without much specificity. EDS is often ignored by the patient and again may only come to light when complained about by family, friends or workmates, or, worse, when it causes an automobile or work related accident.

Other symptoms include:
Morning headache -
Cognitive difficulties. - poor memory/concentration
Personality changes - depression
Gastro-esophageal reflux
Frequent nocturnal urination
Morning sore throat
Dry mouth in the morning
Restlessness
Chest and limb pain
Impotence

Signs of possible presence of obstructive sleep apnea are:

1. Obesity. Most OSA patients are overweight (when defined as greater than 120 percent of ideal body weight). However, the relationship between weight and sleep apnea is not simple. It is well recognized and recently reported that certain groups have increased incidence of OSA in the absence of obesity, (probably related to skull and pharynx anatomy) . Central fat distribution is clearly associated with OSA. In fact, waist circumference has been found to be a better predictor of OSA than neck circumference.

Abdominal obesity may reduce lung volumes when supine, which may in turn reduce respiratory muscle force and reflexively influence upper airway dimensions. Obesity has also been linked quite strongly to changes in upper airway muscle function. Chronic snoring (pneumatic battering) may produce damage to the motor nerves of the tongue and pharynx.

2. A thick neck. Large neck girth in both male and female snorers is a good predictor of OSA. In general, men with a neck circumference of 17 inches or greater and women with a neck circumference of 16 inches or greater are at a higher risk for sleep apnea.

3. Nasopharyngeal narrowing. Nas0phryngeal obstruction is the most common cause of OSA. It is also an important cause in children after pharyngeal flap repair for cleft palate. Nasopharyngeal signs include:

Reddened and thickened pharyngeal mucosa
Long soft palate and uvula
Decreased pharyngeal cross-sectional area
Mandible length (small mandibles reduce posterior airway space)

4. Systemic hypertension and other cardiovascular consequences. In a review of 8 studies (461 patients), an average of 55% of patients with coronary artery disease were found to have OSA. In a similar review of 4 studies (166 patients), an average of 27% of patients with hypertension were found to have OSA. Unexplained pulmonary hypertension may be a sign (but rarely).

5. Cranio-facial abnormalities. The risk of having OSA increases with increasing numbers of affected relatives, independently of age, obesity, and alcohol consumption, and may be the result of facial similarity and underlying facial abnormalities.

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