Diagnostic value of clinical evaluation in obstructive sleep-apnea syndrome cases

Obstructive sleep apnea syndrome (OSAS) affects 1-5% of adult population, and its morbidity and mortality rate is considerably high. Determination of breathing disturbances during sleep is important for prognosis and efficient treatment of the disease. All patients should undergo a full-night polysomnography (PSG) for definite diagnosis of OSAS. However it is an expensive and time consuming study, necessitating special team and instrument. Because the number of sleep laboratories implementing PSG is not sufficient in our country as all over the world, patient selection for PSG is an important issue. For that purpose clinical diagnosis is the most commonly used diagnostic procedure. But, the studies conducted up to date revealed that the patients with OSAS could be diagnosed to a certain degree with clinical assessment.In concordance with other studies, in our study age, body mass index (BMI), neck circumference and Epworth Sleepiness Scala (ESS) values were significantly higher compared to control group. Male : female ratio was 2.8. There was no difference between two groups with respect to smoking. A questionnaire addressing OSAS signs and symptoms showed that witnessed apnea, excessive daytime sleepiness, headache in the morning, fatigue upon waking up in the morning, insufficient/irregular sleep, history of high blood pressure, personality changes, social adjustment problems, hardly falling into sleep in influenza infection, excessive sweating in sleep, nocturia, decrease in libido, and motor vehicle crashes due to sleep during driving were significantly higher in OSAS cases. Snoring, witnessed apnea, fatigue upon waking up in the morning, dry mouth in the morning, and excessive daytime sleepiness are the most specific and sensitive symptoms, respectively. The sensitivity of almost all symptoms were increasing as the severity of disease increased. Motor vehicle crashes due to sleep during driving, social adjustment problems, history of anxiety/depression, hypertension, and sense of palpitation were the symptoms yielded the highest specificity. Comorbidities such as diabetes and hypertension were more frequent in patients with OSAS.These results demonstrated that clinical evaluation was not sufficient for the diagnosis of patients who are at increased risk of OSAS, and these patients should be evaluated together with risk factors, symptoms and comorbidities.