Sleep apnea differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Sleep apnea}} | {{Sleep apnea}} | ||
{{CMG}} | {{CMG}} {{AE}} Saarah T. Alkhairy, M.D. | ||
==Overview== | ==Overview== | ||
Sleep must be differentiated from other diseases that cause loud snoring, fatigue, | 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== | ==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. | |||
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| 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 | | '''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 | | '''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 | | '''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 | | '''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 | ||
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| 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 | | '''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 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; | | '''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 | | '''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 | | '''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 | | '''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 | | '''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|| | | '''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 | | '''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 | | '''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== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Sleep disorders]] | [[Category:Sleep disorders ]] | ||
[[Category:Medical conditions related to obesity]] | [[Category:Medical conditions related to obesity ]] | ||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Primary care]] | [[Category:Primary care]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 14:23, 6 July 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: 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.
| Disease/Condition | Differentiating Signs/Symptoms | 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 |