Differentials
Upper airway resistance syndrome (UARS)
SIGNS / SYMPTOMS
Fragmented sleep results in increased subjective and objective daytime sleepiness. Few clinical centers measure respiratory effort using esophageal probes and therefore UARS is probably an underdiagnosed condition.[12]
INVESTIGATIONS
UARS applies to individuals with increased inspiratory efforts (as identified by esophageal pressure measurements) with frequent arousals, as measured from EEG during diagnostic overnight polysomnography, but without overt apneas and hypopneas.
Obstructive sleep apnea (OSA)
SIGNS / SYMPTOMS
Patients and partners often give a history of cessation of breathing for 10 seconds or more, as well as choking and gasping episodes. They are often obese and have excessive daytime somnolence.
INVESTIGATIONS
A sleep study will diagnose OSA (apnea-hypopnea index of >5).
Pulse oximetry is a useful screening test but may miss mild and moderate OSA.
Polysomnography is the definitive method of sleep study.[12]
Stridor
SIGNS / SYMPTOMS
Occurs during wakefulness. May be relevant history of tumor, inhaled foreign body, neck surgery causing laryngeal nerve injury, or retropharyngeal abscess.
INVESTIGATIONS
Laryngoscopy: may reveal source of upper airways obstruction.
Sleep-related groaning (catathrenia)
SIGNS / SYMPTOMS
Rare. Expiratory vocalization during sleep that has a different vocal quality from expiratory snoring.
INVESTIGATIONS
Sleep studies with special sound recording device: allows differentiation of snoring from other types of noise.
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