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Obstructive Sleep Apnoea

Assessment - History

History of patients with suspected OSA includes sleep behaviours (snoring, arousals, sleeping position), sleep quantity and quality including nocturnal and daytime complaints and physical symptoms, hypertension, cardiovascular disease, type 2 diabetes, thyroid disease, depression, and family history of OSA or CPAP use.

It is important to exclude other causes of daytime sleepiness such as sleep restriction or sleep disorders that require separate advice and management (e.g. insomnia, restless legs syndrome/periodic limb movement).

History taking should include the following variables; sleep quantity / total sleep time, sleep quality / sleep fragmentation / sleep behaviours (e.g., bed and waking times, caffeine and alcohol consumption) / nocturnal awakenings, daytime (e.g. sleepiness) and nocturnal complaints and physical symptoms, and time evolution, severity, circumstances and psychosocial impact of the complaints, possible coexisting disease including hypertension (especially in younger patients), cardiovascular disease (especially atrial fibrillation and heart failure), cerebrovascular disease (stroke and transient ischemic attacks), diabetes mellitus, thyroid disease, and family history of OSA or continuous positive airway pressure (CPAP) use.

History taking from the patient’s bed partner (if present) is an important part of the assessment process, as patients are often not aware of their symptoms, especially snoring and apnoeas.

Daytime sleepiness, a symptom of some but not all patients with OSA, is very common in the general population and therefore other causes should be excluded. The different causes of daytime sleepiness include poor quality (fragmented sleep) and quantity of sleep (sleep restriction), insomnia, circadian rhythm disorders (including shift work sleep disorder), depression, narcolepsy, hypothyroidism, restless legs syndrome/periodic limb movement disorder, sedative medication, a side effect of medication not used for sedation (e.g. some of the antidepressants/anti-epileptics/antipsychotics etc.), stimulants such as caffeine, theophylline, amphetamines, beta-blockers, selective serotonin reuptake inhibitors (SSRIs), excess alcohol intake, neurological conditions including dystrophica myotonica, previous encephalitis, previous head injury, parkinsonism, and idiopathic hypersomnolence.

Table. OSA daytime and nocturnal complaints and physical symptoms1


  • Excessive daytime sleepiness / Hypersomnolence
  • Unrefreshing sleep
  • Morning headaches
  • Morning confusion
  • Difficulty concentrating / poor attention span
  • Irritability
  • Lowered mood
  • Decreased memory
  • Personality / mood changes, including depression and anxiety
  • Sexual dysfunction, including impotence and decreased libido
  • Gastro-oesophageal reflux


  • Snoring
  • Snorting
  • Gasping
  • Choking
  • Dry mouth
  • Witnessed apnoeas
  • Sleep fragmentation
  • Nocturia
  • Insomnia
  • Nocturnal sweating


AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset

Quick links


  1. RACGP gplearning ‘Obstructive Sleep Apnoea’ www.racgp.org.au/education/professional-development/online-learning/gplearning