**1. Introduction**

Although OSA is described as an upper airway disorder occurring during sleep; it should be regarded as a clinical syndrome by taking into consideration its adverse effects on bodily systems. In the presence of symptoms like snoring, sleepiness during daytime, not being able to lose weight, weight increase, apnea observed by close family members, arousal with a feeling of suffocation during the night, profuse sweating of the chest and the neck, nocturnal arrhythmias, nocturia, enuresis, sexual impotence, depression, anxiety, forgetfulness, attention deficit, difficulty in concentration, learning problems, personality changes, deterioration of decision-making ability, morning headaches, dry mouth in the morning, bruxism, gastric reflux symptoms, sleeplessness, abnormal motor activity during sleep, and somnambulance, we should keep OSA in mind. However, all these symptoms guide patients to apply to different medical disciplines, causing confusions of diagnosis and eventually leading to delays in correct diagnoses. When patients have OSA, they can go to "neurology, ear nose throat, dentistry, psychiatry, pulmonology, cardiology, pediatric neurology, pediatric cardiology, internal medicine, neurosurgery, and endocrinology" departments. Therefore, we can say that OSA is a multidisciplinary disease. When we consider the increased workload burden in these disciplines, we appreciate that there can be further delays in establishing an OSA diagnosis in the process. So, in hospitals the diagnosis of sleep physiology and diseases should be made by "clinical physiology, electrophysiology, neurophysiology, and sleep laboratories". Through these laboratories, all medical disciplines should be informed with reports for the correct diagnosis and treatment of these patients, and they should be followed up accordingly.

Despite the advances in the field of sleep medicine, neither the societies nor the physicians are sufficiently informed about sleep and sleep disorders. Among sleep disorders, OSA is very frequent in the population, and it leads to significant consequences. It can adversely influence the school and job success of an individual, his/her social life, marriage, and other relationships while resulting in traffic and occupational accidents. OSA can hinder the cognitive functioning of an individual while increasing the risk for psychiatric and other system-related diseases. Sleep apnea syndrome can play a role in the etiology of severe diseases, namely, hypertension, myocardial infarction, heart failure, stroke, and diabetes. Sleep deprivation brought forward by OSA can increase the number of seizure episodes in epilepsy patients.

This insidious disease has been affecting individuals and societies for many years; it can show itself during sleep, and its effects can deteriorate the performance of the individual during daytime. Complaints of snoring and feeling of suffocation that appear during sleep are mainly identified by the spouse and the close family members of the individual. This disease hinders respiration during sleep and influences all bodily systems and mainly the brain during nighttime. Thus, such patients need to be examined at a sleep and electrophysiology lab by obtaining electrophysiological signal recordings (EEG, EMG, ECG, etc.) throughout the night. This method is called PSG; it establishes the definitive diagnosis for OSA and discriminates it from other sleep disorders and general medical conditions.

Currently, PSG and snoring sound analysis are guiding the diagnosis and treatment of OSA while creating an innovative working field for engineering and medicine.

#### **2. Diagnosis**

#### **2.1 Approach for an OSA patient and clinical signs**

OSA patients generally experience their symptoms during nighttime, and first of all they need to be made aware as they are not aware of them. OSA has many symptoms; the major ones are snoring, apnea as observed by close family members, and excessive sleepiness during daytime. The presence of nocturnal symptoms is more valuable than daytime symptoms when establishing the diagnosis [1]. These patients are generally obese, and they have short and thick necks and narrow upper airways. This type of a body composition is not the rule as the disorder can even be seen in children.

Snoring is the most frequently seen symptom in the presence of sleep breathing disorders. Snoring is a medical and social complaint affecting both sleep and general well-being of children and their parents. When snoring is accompanied by air hunger, feeling of suffocation, or waking up, OSA should be considered. Snoring would not be sufficient by itself for diagnosis as OSA can also happen in the absence of significant snoring. Noisy breathing and increase in the respiratory effort in children during sleep can be the most significant sign. It is typical to have snoring disrupted by frequently repeating apnea in OSA patients. The patients deny snoring. Thus, information needs to be obtained from their partners or close family members. Despite intermissions in snoring and stopping of air exchange in the mouth and nose, abdomen and chest movements continue paradoxically; this results in a panic in people who are witnesses of this situation. Apnea usually ends with a deep breath. At the end of apnea, there can be a loud snoring, a sound of suffocation, coughing, or short arousals [1–6]. Sleep disruption caused by repetitive partial or total airway obstruction in OSA can result in sleepiness during

**131**

**Figure 1.**

*life. And he makes a physical exam of bodily systems.*

*Diagnosis*

*DOI: http://dx.doi.org/10.5772/intechopen.91368*

fore, differential diagnosis needs to be made.

**2.2 Physical examination findings in OSA**

daytime. This situation is correlated with the severity of the disease; mild cases describe sleepiness only during sedentary circumstances, while in advanced cases, sleepiness can even be observed while eating food, talking, or driving. Patients turn and move in bed, and they describe sweating on the upper part of the chest including the neck [2–5, 7]. OSA patients need to breath from the mouth frequently; they talk about complaints like dryness of the mouth or drooling. Neurophysiological changes are weakening of memory and deteriorations in decision-making ability, attention, and concentration, personality changes include aggressiveness or depression, and decreased libido and impotence can as well be seen [1, 8]. There can be night and morning headaches due to decreases in oxygen concentration; these are blunt and widespread in nature. Increases in weight gain and inability to lose weight can be observed, and negative pressure within the chest and abdominal cavity increases because of obstruction resulting in esophageal reflux; patients usually wake up with a chest pain in the form of burning [1, 9]. These symptoms can make one consider several diseases like depression; hypothyroidism; stress; migraine; febrile diseases; metabolic syndrome; chest pain during nighttime due to coronary spasm; arrhythmias; iron deficiency anemia; Cushing syndrome; endocrine and metabolic diseases; heart, kidney, and liver failures; and enuresis nocturia; there-

There is not any specific physical examination finding diagnostic for OSA. By approaching from a wider perspective, evaluation should be made for several disciplines (**Figure 1**). OSA is related to multiple anatomic risk factors. The most important one is central-type obesity with increased body mass index and increased neck circumference. On the other hand, many patients with OSA are not obese, yet they can demonstrate decreased oropharyngeal air space, retrognathia or

*The physician speaks with husband and wife. And he learns by the medical history of the patient, a list of previously used medications, family history, and detailed information about school, work, family, and social* 

## *Diagnosis DOI: http://dx.doi.org/10.5772/intechopen.91368*

*Updates in Sleep Neurology and Obstructive Sleep Apnea*

patients.

medicine.

**2. Diagnosis**

seen in children.

Despite the advances in the field of sleep medicine, neither the societies nor the physicians are sufficiently informed about sleep and sleep disorders. Among sleep disorders, OSA is very frequent in the population, and it leads to significant consequences. It can adversely influence the school and job success of an individual, his/her social life, marriage, and other relationships while resulting in traffic and occupational accidents. OSA can hinder the cognitive functioning of an individual while increasing the risk for psychiatric and other system-related diseases. Sleep apnea syndrome can play a role in the etiology of severe diseases, namely, hypertension, myocardial infarction, heart failure, stroke, and diabetes. Sleep deprivation brought forward by OSA can increase the number of seizure episodes in epilepsy

This insidious disease has been affecting individuals and societies for many years; it can show itself during sleep, and its effects can deteriorate the performance of the individual during daytime. Complaints of snoring and feeling of suffocation that appear during sleep are mainly identified by the spouse and the close family members of the individual. This disease hinders respiration during sleep and influences all bodily systems and mainly the brain during nighttime. Thus, such patients need to be examined at a sleep and electrophysiology lab by obtaining electrophysiological signal recordings (EEG, EMG, ECG, etc.) throughout the night. This method is called PSG; it establishes the definitive diagnosis for OSA and

discriminates it from other sleep disorders and general medical conditions. Currently, PSG and snoring sound analysis are guiding the diagnosis and treatment of OSA while creating an innovative working field for engineering and

OSA patients generally experience their symptoms during nighttime, and first of all they need to be made aware as they are not aware of them. OSA has many symptoms; the major ones are snoring, apnea as observed by close family members, and excessive sleepiness during daytime. The presence of nocturnal symptoms is more valuable than daytime symptoms when establishing the diagnosis [1]. These patients are generally obese, and they have short and thick necks and narrow upper airways. This type of a body composition is not the rule as the disorder can even be

Snoring is the most frequently seen symptom in the presence of sleep breathing disorders. Snoring is a medical and social complaint affecting both sleep and general well-being of children and their parents. When snoring is accompanied by air hunger, feeling of suffocation, or waking up, OSA should be considered. Snoring would not be sufficient by itself for diagnosis as OSA can also happen in the absence of significant snoring. Noisy breathing and increase in the respiratory effort in children during sleep can be the most significant sign. It is typical to have snoring disrupted by frequently repeating apnea in OSA patients. The patients deny snoring. Thus, information needs to be obtained from their partners or close family members. Despite intermissions in snoring and stopping of air exchange in the mouth and nose, abdomen and chest movements continue paradoxically; this results in a panic in people who are witnesses of this situation. Apnea usually ends with a deep breath. At the end of apnea, there can be a loud snoring, a sound of suffocation, coughing, or short arousals [1–6]. Sleep disruption caused by repetitive partial or total airway obstruction in OSA can result in sleepiness during

**2.1 Approach for an OSA patient and clinical signs**

**130**

daytime. This situation is correlated with the severity of the disease; mild cases describe sleepiness only during sedentary circumstances, while in advanced cases, sleepiness can even be observed while eating food, talking, or driving. Patients turn and move in bed, and they describe sweating on the upper part of the chest including the neck [2–5, 7]. OSA patients need to breath from the mouth frequently; they talk about complaints like dryness of the mouth or drooling. Neurophysiological changes are weakening of memory and deteriorations in decision-making ability, attention, and concentration, personality changes include aggressiveness or depression, and decreased libido and impotence can as well be seen [1, 8]. There can be night and morning headaches due to decreases in oxygen concentration; these are blunt and widespread in nature. Increases in weight gain and inability to lose weight can be observed, and negative pressure within the chest and abdominal cavity increases because of obstruction resulting in esophageal reflux; patients usually wake up with a chest pain in the form of burning [1, 9]. These symptoms can make one consider several diseases like depression; hypothyroidism; stress; migraine; febrile diseases; metabolic syndrome; chest pain during nighttime due to coronary spasm; arrhythmias; iron deficiency anemia; Cushing syndrome; endocrine and metabolic diseases; heart, kidney, and liver failures; and enuresis nocturia; therefore, differential diagnosis needs to be made.
