From the Guidelines
Physical exam findings in patients with obstructive sleep apnea (OSA) typically include obesity, increased neck circumference, and a crowded oropharynx, as well as signs of upper airway narrowing or other disorders that can contribute to the development of OSA 1. The physical examination should include an evaluation of the respiratory, cardiovascular, and neurologic systems, with particular attention to the presence of obesity, signs of upper airway narrowing, or the presence of other disorders that can contribute to the development of OSA or to the consequences of OSA 1. Some key features to be evaluated that may suggest the presence of OSA include:
- Increased neck circumference (greater than 17 inches in men or 16 inches in women)
- Body mass index (BMI) over 30
- Crowded oropharynx, which can be assessed using the Mallampati classification
- Retrognathic mandible, enlarged tonsils, elongated uvula, high-arched palate, or nasal obstruction
- Systemic findings such as hypertension, which is often resistant to treatment, or signs of right heart failure if OSA has been longstanding
- Mouth breathing, audible breathing during wakefulness, or witnessed apneas if the patient falls asleep during examination These anatomical features contribute to airway collapse during sleep when muscle tone decreases, leading to the characteristic episodes of breathing cessation. While these physical findings increase suspicion for OSA, definitive diagnosis requires sleep testing, as some patients with OSA may have minimal physical exam abnormalities, and a comprehensive sleep evaluation should be performed in conjunction with diagnostic testing for OSA 1.
From the Research
Physical Exam Findings in Obstructive Sleep Apnea
There are no direct research papers to assist in answering this question, as the provided studies focus on the relationship between obstructive sleep apnea (OSA) and pulmonary hypertension, as well as the effects of continuous positive airway pressure (CPAP) therapy on pulmonary artery pressure.
Related Findings
However, some studies suggest that patients with OSA may have higher pulmonary artery systolic pressure than control subjects 2, and that CPAP therapy can reduce pulmonary systolic pressure levels 2, 3, 4. Additionally, OSA patients with pulmonary hypertension tend to be older, more obese, and have lower daytime oxygenation than those without pulmonary hypertension 4.
Potential Indicators
While not directly addressing physical exam findings, the studies imply that patients with OSA may exhibit signs related to pulmonary hypertension, such as:
- Elevated pulmonary artery systolic pressure
- Increased body mass index (BMI)
- Lower daytime oxygenation
- Older age
These findings are based on studies that investigated the relationship between OSA and pulmonary hypertension, and the effects of CPAP therapy on pulmonary artery pressure 5, 6, 2, 3, 4.