What are the typical symptoms of sleep apnea?

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Last updated: February 12, 2026 • View editorial policy

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Symptoms of Sleep Apnea

Sleep apnea presents with a characteristic triad of nighttime breathing disturbances, daytime dysfunction, and associated physical findings that should prompt immediate diagnostic evaluation.

Nighttime Symptoms

Respiratory Disturbances During Sleep

  • Loud snoring that is audible through a closed door is the most common presenting symptom 1
  • Witnessed apneas (observed pauses in breathing during sleep) reported by bed partners are highly specific for OSA 1
  • Gasping or choking sensations upon awakening from sleep indicate acute airway obstruction 1
  • Snorting sounds during sleep accompany the resumption of breathing after apneic episodes 1, 2

Sleep Quality Disturbances

  • Frequent arousals from sleep without clear cause, leading to fragmented, nonrestful sleep 1
  • Restless sleep with frequent position changes and unusual sleeping positions (particularly in children) 1
  • Nocturia (frequent nighttime urination) is commonly misattributed to prostatic hypertrophy in men but is actually caused by OSA-induced hormonal changes 1, 3
  • Excessive sweating during sleep, particularly in children 1

Daytime Symptoms

Neurocognitive Dysfunction

  • Excessive daytime sleepiness is the primary daytime symptom, with patients feeling unrested despite adequate sleep duration 1
  • Falling asleep easily in nonstimulating environments (watching television, reading, riding in or driving a car) despite believing they had adequate sleep 1
  • Poor concentration and memory deficits affecting work performance and daily activities 1, 3
  • Morning headaches upon awakening that typically resolve within hours 1, 4

Mood and Behavioral Changes

  • Irritability and mood disturbances are common, particularly in untreated patients 5
  • Depression occurs with higher frequency, especially in women with OSA 1, 3
  • In children: behavioral problems, aggression, difficulty concentrating, and symptoms that may mimic attention deficit hyperactivity disorder 1

Physical Examination Findings

Anatomical Risk Factors

  • Obesity with BMI ≥35 kg/m² in adults or ≥95th percentile for age and sex in children 1
  • Increased neck circumference: ≥17 inches (43 cm) in men or ≥16 inches (41 cm) in women 1, 6
  • Craniofacial abnormalities affecting the airway, including retrognathia or micrognathia 1
  • Anatomical nasal obstruction or enlarged tonsils (nearly touching or touching in the midline) 1

Associated Conditions

  • Hypertension, often difficult to control and resistant to treatment, is present in the majority of OSA patients 1, 3
  • Mouth breathing during sleep, particularly in children 1
  • Hyperextension of the neck during sleep in pediatric patients 1

Pediatric-Specific Symptoms

Children present with distinct features that differ from adults:

  • Nocturnal enuresis (new-onset bedwetting) 1
  • Failure to thrive or poor growth despite adequate caloric intake 1
  • Night terrors and unusual vocalizations during sleep 1
  • Difficulty arousing at usual awakening time 1
  • Daytime sleepiness manifesting as hyperactivity rather than fatigue 1

Diagnostic Threshold

A patient should be suspected of having OSA if they exhibit signs or symptoms in two or more of the following categories: (1) predisposing physical characteristics, (2) history of airway obstruction during sleep, or (3) somnolence 1. When these criteria are met, polysomnography is indicated to confirm the diagnosis and determine severity 1.

Critical Clinical Pitfalls

  • Do not dismiss symptoms in non-obese patients, particularly elderly individuals, as OSA can occur without significant obesity in older adults 3, 6
  • Do not attribute nocturia solely to urologic causes in men; evaluate for OSA when nocturia coexists with hypertension or cognitive impairment 3
  • Do not overlook OSA in women, who are significantly underdiagnosed due to provider bias toward screening men preferentially 1
  • Do not misdiagnose pediatric OSA as ADHD; behavioral problems and poor concentration may resolve with OSA treatment 1
  • Recognize that more than 80% of sleep apnea remains undiagnosed in the general population, with serious implications for cardiovascular morbidity and perioperative risk 1, 5

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Guideline

Complications of Uncontrolled Sleep Apnea

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

5
Research

Sleep apnea is a common and dangerous cardiovascular risk factor.

Current problems in cardiology, 2025

6
Guideline

Management of Hallucinations in Elderly Patients with Obstructive Sleep Apnea

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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