| Clinical Features of Adult OSAS | Symptoms and Signs of Pediatric OSAS |
|---|---|
| Breathing disturbances during sleep | Nocturnal Symptoms |
| Habitual, socially disruptive snoring | Snoring |
| Witnessed apneas | Gasping |
| Gasping or choking | Noisy breathing (typically inspiratory) |
| Difficulties maintaining sleep | Paradoxical breathing |
| Snort arousals | Retractions (cervical or costal) |
| Dyspnea spells | Witnessed apneas |
| Restlessness | Restless sleep |
| Nocturia | Neck hyperextension |
| Diaphoresis | Mouth breathing |
| Gastroesophageal reflux | Nocturnal sweating |
| Daytime dysfunction | Enuresis (after 6 mo continence) |
| Nonrestorative sleep Excessive daytime sleepiness in a nonstimulating environment (eg, watching TV, reading, riding in/driving a car) | Parasomnia (walking, talking, terrors) Bruxism Mouth breathing Daytime Symptoms |
| Motor vehicle accidents, especially a history of “falling asleep at the wheel” | Difficulty waking Unrefreshed on waking |
| Impaired concentration, cognition, or memory | Excessive sleepiness |
| Headaches upon arising | Hyperactivity |
| Mood lability | Aggression/moodiness |
| Weakened libido | Mouth breathing |
| Risk factors | Poor appetite |
| Obesity | Dysphagia |
| Smoking | Difficulty in school |
| Nasal congestion | Signs/Findings |
| Alcohol | Tonsil hypertrophy |
| Sedative/hypnotics | High/large tongue position |
| Opioid analgesics | Growth disturbance |
| Supine (on the back) sleep positioning | Obesity |
| Comorbidities | Failure to thrive |
| Hypertension | Pulmonary hypertension |
| Myocardial infarction | Systemic hypertension |
| Congestive heart failure | Craniofacial abnormalities |
| Stroke | Laryngomalacia |
| Pulmonary hypertension | Nasal airway obstruction |
| Diabetes/metabolic syndrome | HypotoniaGastroesophageal reflux |
Column 1 (adult) adapted from Ref. 23. Column 2 (pediatric) reprinted from Ref. 16.
OSAS, obstructive sleep apnea syndrome.