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
- Sleep fragmentation
- Fatigue
- Usage of long-acting opioid medication[1]
Asthma Chronic Obstructive Pulmonary Disease Depression Gastroesophageal Reflux Disease Hypothyroidism Narcolepsy Periodic Limb Movement Disorder
Pseudocentral sleep apnea: Patients with diaphragmatic paralysis and other neuromuscular diseases, who are dependent on accessory muscles of breathing to maintain ventilation, may appear to have central apneas during rapid eye movement (REM) sleep. This is due to the REM atonia of skeletal muscles. Many of these patients actually have obstructive sleep apnea but do not have enough diaphragmatic excursions to be recorded by the piezoelectric belts used during routine PSG. A history of neuromuscular disease and worsening of central apneas during REM sleep should alert to the possibility of pseudocentral apnea.
Sleep-related hypoventilation syndrome: Sleep-related hypoventilation with central sleep apneas can be observed in many conditions, such as neuromuscular weakness or chronic obstructive pulmonary disease. These conditions are characterized by a history of a preexisting disorder of hypoventilation, elevated resting PaCO2, and severe oxygen desaturation during sleep, which is more prominent during REM sleep in contrast to primary centralSLEEP APNEA and Cheyne-Stokes breathing-central sleep apnea (CSB-CSA), which are mostly observed during NREM sleep.
References
- ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.