Focused History Questions for an 18-Year-Old Male with Suspected Obstructive Sleep Apnea
Ask about the cardinal triad of OSA symptoms—snoring, witnessed apneas, and excessive daytime sleepiness—and obtain collateral history from a bed partner or family member whenever possible. 1, 2
Core Nocturnal Symptoms
- Snoring characteristics: Ask about frequency, loudness, and whether it disturbs others in the household. 2
- Witnessed apneas: Specifically ask family members if they have observed episodes where breathing stops during sleep. 2, 3
- Gasping or choking episodes: Inquire about sudden arousals with breathlessness or a sensation of suffocation. 2, 3
- Nocturia: Document frequent nighttime urination, which occurs due to atrial natriuretic peptide release from right atrial stretch in OSA. 1, 2
- Sleep fragmentation: Ask about difficulty staying asleep throughout the night or frequent awakenings. 2
Daytime Symptoms and Functional Impact
- Excessive daytime sleepiness: Use the Epworth Sleepiness Scale (ESS) to quantify sleepiness objectively rather than relying on subjective reports alone. 1, 2
- Total sleep duration: Record habitual sleep hours to differentiate true OSA-related sleepiness from simple sleep deprivation. 2
- Cognitive difficulties: Ask about reduced concentration, memory problems, or difficulty with daily tasks. 2, 4
- Morning headaches: Specifically ask about headaches present upon awakening that typically resolve within a few hours. 2, 4
- Motor vehicle incidents: Document any accidents or near-miss events that may result from decreased alertness. 2, 5
Medical Comorbidities and Risk Factors
- Cardiovascular conditions: Screen for hypertension (especially treatment-resistant), atrial fibrillation, heart failure, or history of stroke—all strongly associated with OSA. 1, 2, 4
- Metabolic disorders: Ask about type 2 diabetes or insulin resistance. 1, 2, 4
- Hypothyroidism: This condition is associated with OSA, particularly in women, but should be considered in all patients. 1
- Depression: Document any history of depression, as it can both mimic OSA symptoms and coexist with the disorder. 1
- Obesity: While important, recognize that OSA can occur in non-obese young adults—in males with BMI ~27 kg/m² and classic symptoms, OSA prevalence reaches 84%. [6, @29@]
Medication and Substance Use History
- Sedating medications: Obtain a detailed list of all prescribed and over-the-counter medications, particularly sedative-hypnotics and opiate analgesics, which can worsen breathing difficulties during sleep or produce daytime sleepiness. 1
- Alcohol use: Inquire about alcohol consumption, as it can exacerbate upper airway collapse. 1, 3
- Smoking history: Document cigarette smoking, which is a risk factor for OSA. 3, 5
Anatomical and Physical Examination Clues
- Neck circumference: Measure neck size; values >17 inches in men suggest higher OSA risk. 1, 2, 6
- Craniofacial features: Ask about or examine for retrognathia (recessed jaw), micrognathia, or other jaw abnormalities. 1, 2
- Nasal obstruction: Inquire about chronic nasal congestion, mouth breathing when awake, or chronic rhinorrhea. 6
- Tonsillar hypertrophy: While more common in children, enlarged tonsils can contribute to OSA in young adults. 6
Critical Pitfalls to Avoid
- Do not dismiss symptoms in non-obese young adults: OSA prevalence can reach 15% (ODI ≥15 events/hour) even in young males aged 20-50 years with normal BMI. 6
- Do not rely solely on patient-reported symptoms: 78% of patients with confirmed OSA denied common symptoms of snoring and sleepiness, so absence of reported symptoms does not exclude OSA. 6
- Always obtain collateral history: The patient may be unaware of snoring, apneas, or abnormal sleep behaviors that are obvious to bed partners or family members. 1
- Screen routinely during health maintenance visits: Ask all patients whether they snore, experience daytime sleepiness, are obese, have a recessed jaw, or have hypertension—positive answers should prompt a full sleep history. 2