Sleep apnea physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.
Overview
Generally, the most common signs of sleep apnea are a large waist/neck circumference and facial deformities. If sleep apnea is left untreated, signs of for pulmonale, stroke, hypoxemia, and pulmonary hypertension are evident.
Sleep Apnea Physical Examination
General appearance
- Lethargy
- Confusion
- Irritable
- Sitting up and leaning forward to improve diaphragmatic breathing
- Children may not grow at a normal rate
Vital Signs
Vital signs are generally within normal limit, but patients with severe disease may have the following vital signs:
- Decreased SPO2
- Tachyapnea
- Tachycardia
- High BP
Chest
- Wheeze
- Pleural effusion
Heart
- Right ventricular hypertrophy (RVH)
- Left parasternal systolic lift
- 3rd/4th heart sounds and pansystolic murmur of tricuspid regurgitation over right heart
- Split second heart sound with loud pulmonary component
- Systolic ejection murmur with a sharp ejection click over the pulmonary artery
- Diastolic pulmonary regurgitation murmur over the pulmonary artery
Abdomen
- Ascites
- Hepatomegaly
- Large waist circumference
Skin
ENT
- Large neck circumference
- Particularly prominent among men who have a collar size greater than 17 inches and women who have a collar size greater than 16 inches[1]
- Retrognathia
- Micrognathia
- Lateral peritonsillar narrowing
- Macroglossia
- Tonsillar hypertrophy
- Elongated or enlarged uvula
- A high arched or narrow palate
- Nasal septal deviation
- Nasal polyps
- Increased jugular venous pressure
- Prominent neck and facial veins
Extremeties
- Digital clubbing
- Pedal edema