Last reviewed: June 2020
Last updated: January  2018



History and exam

Key diagnostic factors

  • obesity
  • male gender
  • maxillomandibular anomalies
  • excessive daytime sleepiness
  • episodes of apnea
  • episodic gasping
  • restless sleep
  • insomnia
  • macroglossia
  • chronic snoring

Other diagnostic factors

  • cardiovascular disease
  • weight gain
  • large neck circumference
  • endocrine disorders
  • hx of difficult intubation for general anesthesia
  • FHx of OSA or snoring
  • hx of mucopolysaccharidoses
  • hx of GERD
  • hx of Down syndrome
  • hx of tooth extractions for crowding
  • hx of motor vehicle accidents
  • neurocognitive dysfunction
  • mood disorders
  • nocturia
  • erectile dysfunction
  • morning headaches
  • heartburn/dyspepsia
  • dry mouth
  • nocturnal sweating

Risk factors

  • obesity
  • male gender
  • postmenopause (women)
  • large neck circumference
  • maxillomandibular anomalies (e.g., narrowing, retrognathia, and high, arched palate)
  • increased volume of soft tissues (includes tonsils, adenoids, and tongue)
  • FHx of OSA
  • chronic snoring
  • nasal obstruction
  • polycystic ovary syndrome
  • levels of sex hormones
  • hypothyroidism
  • Down syndrome
  • mucopolysaccharidoses
  • alcohol use
  • increasing age
  • black, Hispanic, or Asian ethnicity
  • tobacco smoking

Diagnostic investigations

1st investigations to order

  • polysomnography (PSG)
  • portable multichannel sleep tests
  • awake fiberoptic endoscopy
More 1st investigations to order

Emerging tests

  • cine MRI
  • drug-induced sleep endoscopy (DISE)
  • cardiovascular and neurological tests
  • biochemical or genetic signatures and assays
More emerging tests

Treatment algorithm


Assistant Clinical Professor

Department of Otolaryngology

Icahn School of Medicine at Mount Sinai

New York



OJ is an unpaid advisor for ImThera medical and has received research funding support from ImThera Medical for the THN2 and THN3 FDA clinical trials. This topic discusses implantable hypoglossal neurostimulation devices and ImThera Medical is 1 of 3 companies in this field. Discussion is limited to available scientific evidence and there is no contractual agreement to disseminate product information. OJ is a consultant for Nyxoah Medical, which is developing a new implantable hypoglossal neurostimulation device. This device is not mentioned in the topic, as no published studies exist at the time of publication. The general topic is included in the topic. There is no contractual agreement to disseminate product information.

Peer reviewersVIEW ALL

Professor of Medicine

Bahiana School of Medicine and Public Health



CD has been reimbursed by Sanofi-Aventis, Novartis, Merck Sharp Dohme, and Eli Lilly as investigator of clinical trials.

Adjunct Assistant Professor

University of Utah


Pulmonary & Critical Care Research

IHC Urban South Intermountain Utah Valley Pulmonary Clinic




KMS declares that he has no competing interests.

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