Clinical features

Possible clinical features include:

• loud snores
  • typically present for many years (often from childhood)
  • may be exacerbated following the ingestion of alcohol before bedtime or following an increase in body weight
• apnoeic episodes characterized by cessation of breathing/choking episodes
  • usually noticed by the bed partner and sometimes he/she may awaken the patient to reestablish the breathing
  • termination of the apnoeic event is often associated with loud snores and vocalizations that consist of gasps, moans, or mumblings
  • patients are often unaware of these loud snoring and breathing difficulty or of the frequent arousals and brief awakenings that occur throughout the night.
• excessive daytime sleepiness
  • most common presenting symptom
  • causes day time fatigue and concentration difficulties
  • occurs when the patient is relaxing e.g. - when sitting, reading or watching television
  • in extreme cases patient may fall asleep while actively conversing, eating, walking or driving
• in addition there can be symptoms which are commonly observed upon awakening
  • feeling unrefreshed
  • feelings of disorientation, grogginess, mental dullness, and incoordination
• severe dryness of the mouth – often results in patient drinking water during the night or upon waking in the morning
• morning headaches – characteristically dull and generalized and often lasts for 1-2 hours
• irritability, changes in personality
• nocturia
• loss of libido
• sleep quality of bedpartners may also be affected (1,2,3)

Note:

• obstructive sleep apnoea may be a modifiable factor for vascular disease

Reference:

• (1) American Academy of Sleep Medicine. The international classification of sleep disorders, revised. Diagnostic and coding manual
• (2) Greenstone M, Hack M. Obstructive sleep apnoea. BMJ. 2014;348:g3745
• (3) Parati G et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Respir J. 2013;41(3):523-38