SLEEP APNEA

SLEEP APNEA: Excerpt from Differential Diagnosis in Primary Care

The differential diagnosis of sleep apnea may be arrived at by utilizing both physiology and anatomy. Normal sleep requires an unobstructed pathway from the nasopharynx to the lung and an intact central nervous system that responds to anoxia and the accumulation of CO₂ in the blood. It follows that sleep apnea may result from an obstructed airway (obstructive sleep apnea) or central suppression of respiration (central sleep apnea). Obstructive sleep apnea. Think of the things that may obstruct the airway and many causes will come to mind. A deviated nasal septum, chronic infective or allergic rhinitis and sinusitis, tonsillitis and enlarged tonsils, obesity causing an enlarged soft palate or tongue, hypothyroidism, or acromegaly causing an enlarged tongue and nasal polyps must be considered. A small chin, deep overbite, or short neck may be the cause. Pickwickian syndrome may cause obstructive sleep apnea because of the associated obesity. Central sleep apnea. Conditions that contribute to chronic anoxia such as congestive heart failure (CHF), Pickwickian syndrome, arteriovenous (A-V) malformations (septal defects, e.g.), and pulmonary fibrosis may be associated with this disorder. Conditions that cause chronic CO₂ retention such as pulmonary emphysema may also be causes. Finally, diseases of the central nervous system that depress the respiratory center may be involved. These include poliomyelitis, chronic drug or alcohol use, residual damage from viral encephalitis, brainstem tumors, and multiple sclerosis.

Approach to the Diagnosis

A thorough examination of the upper respiratory system is essential: It may be wise to get an otolaryngologist to do this. A CBC to rule out anemia and arterial blood gases to rule out anoxia and hypercarbia may be helpful. Spirometry, chest x-ray, echocardiogram (ECG), and arm-to-tongue circulation time will help to rule out pulmonary and cardiovascular disorders. Ultimately, overnight polysomnography will be required to secure the diagnosis. A pulmonologist or otolaryngologist ought to be consulted before ordering this expensive test.

Pictures

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

More About Sleep apnea

• Back to disease: Sleep apnea: Introduction
• Next Book Extract About Sleep apnea: Consider that patients with snoring may have obstructive sleep apnea syndrome (OSAS) (Avoiding Common Pediatric Errors)
• More Book Extracts: All Online Books for Sleep apnea

More Medical Textbooks Online about Sleep apnea

Review other book chapters online related to Sleep apnea:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

 » Next page: Consider that patients with snoring may have obstructive sleep apnea syndrome (OSAS) (Avoiding Common Pediatric Errors)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Consider that patients with snoring may have obstructive sleep apnea syndrome (OSAS) (Avoiding Common Pediatric Errors)
• Sleep Apnea—Obstructive Sleep Apnea Syndrome (The 5-Minute Pediatric Consult)
• Surveys relating to Sleep apnea
• Ask Question about Sleep apnea

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City