Clinical Assessment of OSA Patients

Abstract

While sleep studies are indispensable in the diagnostic process of obstructive sleep apnea patients, clinical examination should not be neglected. Assessment begins with a comprehensive history, including heteroanamnesis provided by the patient’s bed partner. It is important to identify or determine any risk factors and comorbidities, as these can sometimes point toward sleep-disordered breathing. Clinical inspection of the upper airway is important, as it can reveal anatomical structures responsible for the patient’s complaints. Such clinical inspection is the domain of an otolaryngologist, and it requires detailed knowledge of the upper airway’s functional anatomy. Obstruction at the level of the epiglottis cannot yet be reliably predicted without drug-induced sleep endoscopy; however, clinical assessment can provide more information than previously believed. In order to minimize inter-examiner variability, to enable standardized reporting, to improve interpretation, and to allow comparison of research results, a uniform and standardized classification system of upper airway observations should be used. While several proposals have been put forth in recent publications, a widely accepted grading system for the laryngeal status has not yet been established.