Sleep apnea physical examination

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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

Generally, the most common signs of sleep apnea are a large waist/neck circumference and facial deformities. If sleep apnea is left untreated, signs of for pulmonale, stroke, hypoxemia, and pulmonary hypertension are evident.

Sleep Apnea Physical Examination

General appearance

• Lethargy
• Confusion
• Irritable
• Sitting up and leaning forward to improve diaphragmatic breathing
• Children may not grow at a normal rate

Vital Signs

Vital signs are generally within normal limit, but patients with severe disease may have the following vital signs:

• Decreased SPO2
• Tachyapnea
• Tachycardia
• Hypertension

Chest

• Wheeze
• Pleural effusion

Heart

• Right ventricular hypertrophy (RVH)
• Heart murmurs

Abdomen

• Ascites
• Hepatomegaly

Skin

• Cyanosis

ENT

• Large neck circumference

• Particularly prominent among men who have a collar size greater than 17 inches and women who have a collar size greater than 16 inches

• Retrognathia
• Micrognathia
• Lateral peritonsillar narrowing
• Macroglossia
• Tonsillar hypertrophy
• Elongated or enlarged uvula
• A high arched or narrow palate
• Nasal septal deviation
• Nasal polyps
• Increased jugular venous pressure
• Prominent neck and facial veins

Extremeties

• Digital clubbing
• Pedal edema