Last reviewed: November 2017
Last updated: October  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • insomnia, especially sleep-maintenance insomnia
  • poor concentration and attention span
  • observed periodic breathing or cessation of breathing or snoring during sleep (by partner)
  • transient dyspnoea that awakens from sleep or prevents sleep onset
  • headaches upon arising
  • complaints of poorly restorative sleep and/or daytime sleepiness
  • periodic breathing during wakefulness

Other diagnostic factors

  • abnormal heart rhythm or the presence of third or fourth heart sounds
  • focal abnormality on neurological examination
  • neuromuscular weakness
  • hx of endocrine disorders

Risk factors

  • CHF
  • stroke
  • renal failure
  • male sex
  • atrial fibrillation
  • age ≥60 years
  • opioid use
  • brainstem lesions
  • neuromuscular weakness
  • acromegaly
  • hypothyroidism

Diagnostic investigations

1st investigations to order

  • overnight polysomnography
Full details

Investigations to consider

  • serum TSH
  • serum creatinine
  • ECG
  • serum insulin-like growth factor 1 (acromegaly testing)
  • echocardiogram
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Assistant Professor of Medicine

Division of Pulmonary and Critical Care Medicine

Mayo Clinic

Rochester

MN

Disclosures

BJS declares that he has no competing interests.

Associate Professor of Medicine

Division of Pulmonary and Critical Care Medicine

Yale University School of Medicine

New Haven

CT

Disclosures

CHW declares that she has been a speaker for Respironics CME.

Dr Bernardo J. Selim and Dr Christine H. Won would like to gratefully acknowledge Dr J. Shirine Allam and Dr Timothy I. Morgenthaler, previous contributors to this monograph. JSA and TIM declare that they have no competing interests.

Peer reviewers VIEW ALL

National Jewish Medical and Research Center

Denver

CO

Disclosures

TLC has been reimbursed by the American College of Chest Physicians (ACCP), American Academy of Sleep Medicine, American Thoracic Society, and Cephalon, the manufacturer of modafinil, for attending several conferences. He has been paid by the ACCP for running educational programs and by Elsevier for serving as consultant of the Sleep Medicine Clinics. He has also received research funding from the National Institutes of Health, Respironics, Restore, and Schwarz Pharma, and has been a member of the speakers' bureau for GlaxoSmithKline.

Professor

University of British Columbia

Vancouver

Canada

Disclosures

JAF declares that he has no competing interests.

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