Sleep apnea differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2]
Overview
Sleep must be differentiated from other diseases that cause loud snoring, fatigue, or daytime sleepiness.
Differential Diagnosis
| 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 can 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 can 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 | Daytme fatigue is 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 can be performed |