SLEEP APNEA
SLEEP APNEA: Excerpt from Differential Diagnosis in Primary Care
The differential diagnosis of sleep apnea may be arrived at by utilizing both physiology and anatomy. Normal sleep requires an unobstructed pathway from the nasopharynx to the lung and an intact central nervous system that responds to anoxia and the accumulation of CO2 in the blood. It follows that sleep apnea may result from an obstructed airway (obstructive sleep apnea) or central suppression of respiration (central sleep apnea).
SLEEP APNEA
Obstructive sleep apnea
Think of the things that may obstruct the airway and the many causes will come to mind. A deviated nasal septum, chronic infective or allergic rhinitis and sinusitis, tonsillitis and enlarged tonsils, obesity causing an enlarged soft palate or tongue, hypothyroidism, or acromegaly causing an enlarged tongue and nasal polyps must be considered. A small chin, deep overbite, or short neck may be the cause. Pickwickian syndrome may cause obstructive sleep apnea because of the associated obesity.
Central sleep apnea
Conditions that contribute to chronic anoxia such as CHF, pickwickian syndrome, A-V malformations (septal defects, etc.) and pulmonary fibrosis may be associated with this disorder. Conditions that cause chronic CO2 retention such as pulmonary emphysema may also be the cause. Finally, diseases of the central nervous system that depress the respiratory center may be involved. These include poliomyelitis, chronic drug or alcohol use, residual damage from viral encephalitis, brainstem tumors, and multiple sclerosis.
Approach to the Diagnosis
A thorough examination of the upper respiratory system is essential: It may be wise to get an otolaryngologist to do this. A CBC to rule out anemia and arterial blood gases to rule out anoxia and hypercarbia may be helpful. Spirometry, chest x-ray, ECG, and arm-to-tongue circulation time will help rule out pulmonary and cardiovascular disorders. Ultimately, overnight polysomnography will be required to secure the diagnosis. A pulmonologist or otolaryngologist ought to be consulted before ordering this expensive test.
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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