clinical assessment

Last reviewed 01/2018

It is recommended that physicians obtain a sleep history in the following children who presents to the primary care:

• symptoms of blocked nose
• recurrent nasal or throat infections
• recurrent ear infections
• parents are concerned about snoring

The following list of question may be useful elicit daytime and night time symptoms associated with disordered breathing:

• ask about night time symptoms
• do they snore?
• do they get a good night's sleep or are they restless?
• do they wake through the night?
• do they struggle with their breathing or stop breathing?
• do they sleep in an unusual position (such as with extended head)?
• do they sweat excessively?
• do they wet the bed?
• ask about daytime symptoms
• do they have any behavioural or concentration problems?
• do they breathe through their mouth?
• are they growing normally?

In primary care the following examination can be carried out in patients with suspected OSA:

• nasal airflow  
• can be assessed by holding a cold spatula or tongue depressor under the nose - misting of the cold metal indicates airflow and absence of it may indicate nasopharyngeal obstruction resulting from enlarged adenoids or nasal obstruction, usually caused by rhinitis
  
  
• examination of the nasal cavity - for the presence of rhinitis or obstructive polyps
  
  
• tonsillar size and presence of any abnormality of the palate - can be done by assessing the mouth and pharynx
• tonsils can be graded according to the percentage of how much the oropharyngeal airway is occupied
• grade 0: Within tonsillar fossa
• grade 1: 0-25% of oropharyngeal airway
• grade 2: 26-50%
• grade 3: 51-75%
• grade 4: > 75%
  
  
• neck should be examined for lymphadenopathy
  
  
• ears - glue ear may co-exist with adenoid hypertrophy (1)

Reference:

• (1) Powell S et al. Paediatric obstructive sleep apnoea. BMJ. 2010;340:c1918