Sleep Apnea

A. Selected symptoms

· Night: snoring, choking, heavy sweating, reflux;

restless sleep, sleepwalking

· Day: morning headaches, hypersomnolence, automatic behavior, emotional outbursts, depression/psychosis/mania, cognitive impairment.

B. Evaluation

· Screen with Epworth Sleepiness Scale

· If score³9, take detailed sleep history, perform PE, obtain labs.

· Definitive diagnosis requires polysomnography

C. The Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation:

0 = no chance of dozing, 1= slight, 2 = moderate, 3 = high

Sitting and reading ____________

Watching TV ____________

Sitting inactive in a public place ____________

A passenger in a car for an hour ____________

Lying to rest in the afternoon ____________

Sitting & talking to someone ____________

Sitting quietly after lunch ____________

Stopped a few minutes in traffic ____________

source: Smallwood P (1998) Medicine and Psychiatry 1: 42-52.