Diagnosis of sleep apnea.

Rapidly accumulating evidence shows that sleep apnea is a major factor influencing personal health and public safety. Diagnosis and treatment of this syndrome may well result in significant preventive medicine outcomes. The prevalence of sleep apnea is so high that evaluation and treatment must become the province of the primary care physician. Accurate, appropriate history, physical assessment and clinical management are the mainstays of care, with the judicial application of technology. A history of snoring, particularly when it is intermittent, interrupted by snorts, and accompanied by restless sleep or daytime sleepiness suggests the need for further evaluation. When co-morbid conditions such as hypertension, cardiovascular disease or type 2 diabetes are present, formal evaluation and consideration of treatment are needed. If initial evaluation reveals severe obstructive sleep apnea with observed apneas, together with excessive daytime sleepiness, clinical management with empirical application of continuous positive airway pressure (CPAP) may suffice in experienced hands.