Table 2.

Day and night can be distinguished with respect to the major signs and symptoms of obstructive sleep apnea syndrome (OSAS)

A. Nocturnal symptoms

Snoring and observed apnea are the most frequent and hallmark nocturnal symptoms of OSAS, both of which reflect the critical narrowing of the upper airway. Nocturnal asphyxia also appears to be helpful in identifying patients with OSAS

a. Snoring: Snoring is the most characteristic nocturnal symptom of OSAS; patients with OSAS tend to have a long-standing history of snoring, which becomes increasingly intense and irregular over time

b. Observed apneas: Apneas are a frequent cause of consultation, since they often cause concern for the partner of the patient, describing them as respiratory pauses that interrupt snoring while the patient continues to struggle to breathe. Apnea alternates with snoring, and apneas occur after cessation of snoring, accounting for ~40% of sleep time

c. Arousals: Patients may experience arousal or distress when they experience apnea, feelings of terror, hand swings, or body movements. Arousals are less frequent than observed apneas. This symptom is associated with hypertension, since recurrent arousals are related to sympathetic discharges that elevate blood pressure and heart rate

d. Other: Night sweats, nocturia, restless sleep, somniloquy, and symptoms of gastroesophageal reflux are additional nocturnal symptoms related to OSAS

B. Daytime symptoms

a. Daytime sleepiness: Most patients have significant excessive daytime sleepiness (EDS), poor concentration and tiredness, which is due to sleep fragmentation. In addition, morning distension or headache, apathy, depression, irritability and/or changes in affect, memory loss, social issues, decreased libido, and erectile dysfunction are other characteristic daytime symptoms of patients with OSAS