View source for Sleep apnea differential diagnosis

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{{Sleep apnea}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.

==Overview==
Sleep must be differentiated from other diseases that cause loud snoring, fatigue, choking, coughing, and daytime sleepiness. To differentiate obstructive sleep apnea (OSA) and central sleep apnea, a [[polysomnogram]] should be performed. OSA will show evidence of thoracoabdominal effort, whereas central sleep apnea will not.

==Differential Diagnosis==
The table below summarizes the findings that differentiate sleep apnea from other conditions that cause loud snoring, fatigue, choking, coughing, or daytime sleepiness.

{| {{table}}

| align="center" style="background:#f0f0f0;"|'''Disease/Condition'''

| align="center" style="background:#f0f0f0;"|'''Differentiating Signs/Symptoms'''

| align="center" style="background:#f0f0f0;"|'''Differentiating Tests'''

|-

| '''Cheyne-Stokes respiration (CSB)'''||Recurrent episodes of apnea with absence of respiratory effort; CSB is associated with [[cerebrovascular disease]], [[CHF]], or [[renal failure]] ||In CSB, a crescendo-decrescendo change in breathing amplitude interpersed by episodes of central sleep apnea or hypoapnea would be seen

|-

| '''Narcolepsy'''||Level of sleepiness in narcolepsy may be higher in [[Epworth Sleepiness Scale]]; may have [[cataplexy]]  hypnagogic hallucincations, and sleep paralysis||A [[polysomnography]] should be performed to rule out OSA; a [[multiple sleep latency test]] (MLST) can assess for naroclepsy

|-

| '''Insufficient sleep'''||Difficult to differentiate clinically||A [[polysomnography]] should be performed to rule out OSA; a sleep diary should used

|-

| '''Inadequate sleep hygiene'''||Irregular sleep schedule with frequent napping; frequent use of  alcohol, nicotine, and caffeine; poor bedroom environment||A [[polysomnography]] should be performed to rule out OSA; diagnosis is usually clinical

|-

| '''Periodic limb movement disorder'''||Patients describe an urge to move legs due to discomfort during periods of inactivity (including sleep); patients have excessive sleepiness||A [[polysomnography]] should demonstrate limb movements and rule out OSA

|-

| '''Nocturnal gastroesphageal reflux'''||Results in [[nocturnal]] restlessness, choking episodes during sleep, frequent awakening, and labored breathing||A [[polysomnography]] should be performed to rule out OSA

|-

| '''Nocturnal asthma'''||Can present with [[nocturnal]] choking, gasping, coughing, or shortness of breath||A [[polysomnography]] should be performed to rule out OSA; [[pulmonary function tests]] (PFTs) should be performed

|-

| '''Primary snoring'''||More common than OSA||A [[polysomnography]] should be performed to rule out OSA

|-

| '''Nocturnal panic attacks''' ||Can present with [[nocturnal]] choking, gasping, coughing, or shortness of breath||A [[polysomnography]] should be performed to rule out OSA; a psychiatric history should be performed

|-

| '''Congestive heart failure'''||Can present with [[nocturnal]] choking, gasping, coughing, or shortness of breath||A [[polysomnography]] should be performed to rule out OSA; [[EKG]], [[chest x-ray]], blood tests, [[stress testing]], and [[cardiac catheterization]] should be performed

|-

| '''Sleep-related laryngospasm'''||Can present with [[nocturnal]] choking, gasping, coughing, or shortness of breath||A [[polysomnography]] should be performed to rule out OSA

|-

| '''Chronic fatigue syndrome'''||Daytime [[fatigue]] is usually the only complaint||A [[polysomnography]] should be performed to rule out OSA

|-

| '''Depression'''||Can present with [[fatigue]] and feelings of hopelessness||A [[polysomnography]] should be performed to rule out OSA; a psychiatric history should be performed

|-

| '''Pseudocentral sleep apnea''' ||These patients with diaphragmatic paralysis depend on accessory muscles during breathing and may have [[apnea]] during REM sleep (sleep apnea is mostly observed during non-REM sleep); history of [[neuromuscular disease]]||A [[polysomnography]] should be performed to rule out OSA; various neuromuscular disease tests should be performed

|}

==References==

{{Reflist|2}}

[[Category:Sleep disorders ]]
[[Category:Medical conditions related to  obesity ]]
[[Category:Pulmonology]]
[[Category:Cardiology]]
[[Category:Primary care]]

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