A careful history and physical examination can provide the initial clues to the possible diagnosis of OSA. Finding suggestive of OSA include:

Loud Snoring: Snoring of any intensity raises the possibility of OSA. The louder the snoring, the more likely the presence of significant upper airway obstruction during sleep.

IMPORTANT NOTE: One of the most interesting findings in sleep research is that snoring itself does not produce sleep apnea. Nasal congestion by itself can lead to snoring without causing any degree of sleep apnea.

Witnessed Cessation in Breathing: Witnessed momentary "stops" in breathing (apnea) by the bed partner (especially those greater than 10 seconds) are a significant finding in the medical history that is strongly suggestive of OSA.

Daytime Sleepiness: OSA produces daytime sleepiness. Falling asleep while driving or working is a significant finding for possible OSA.

Obesity: Two-thirds of the patients with OSA are obese.

Male Gender: OSA is more common in men than in women.

History of Hypertension: 30% of patients with "essential hypertension" have OSA.

History of Coronary Artery Disease: A history of CAD may be tied to OSA. In addition, OSA can result in a serious "cardiac event" for patients with existing CAD.

Laboratory Tests Used to Diagnose OSA

OSA can not be diagnosed solely by a medical history. A sleep study is required. Overnight sleep studies, called polysommograms, are performed at "sleep disorder clinics."

Polysommograms are usually done using a "split-night" format. In a split-night format the first half of the sleep study involves getting data on the person’s sleep. The goal is to verify OSA and the severity of the "apnea events."

Once OSA has been verified and measured, the second half of the sleep study involves using a special breathing mask and a "pressure machine" (the system is called CPAP) to relieve the OSA.

The severity of a person’s OSA is generally reported in three ways:

Apnea Index (AI) This is the number of apnea events per hour recorded during the sleep study.

SaO2 "minimum" This is the minimum blood oxygen saturation level.

Respiratory Distress Index (RDI) This is the sum of the "apnea events" and is used in most sleep disorder labs as a measure of sleep distress. The higher the RDI, the more severe the OSA:

RDI < 5 Normal
RDI > 5 Accepted level for diagnosis of OSA
RDI >6 but <15 Mild OSA
RDI >16 but <30 Moderate OSA
RDI >30 Severe OSA

IMPORTANT NOTE:Some sleep labs also require that the SaO2 "minimum" be <80% for a diagnosis of "severe" OSA.

Treatment of OSA

Current treatments of OSA include:

Pressure devices
Continuous positive pressure (CPAP): bilevel pressure (BIPAP); and auto-titrating continuous positive pressure (ATAP).
(CPAP, BIPAP and ATAP work best in the moderate to severe category of OSA)

Oral appliances
(These are not considered "first-line" therapy for severe OSA by may be helpful for individuals who fail CPAP)

Upper airway surgical reconstruction
(These form of treatment works best with patients with "structural problems" of the upper airway)

IMPORTANT NOTE: The type of treatment often depends on how the patient enters the health care system. Pulmonary/sleep physicians generally recommend CPAP, dentists recommend oral appliances and ENT physicians or facial surgeons tend to favor reconstruction.

The current approaches to the treatment of OSA are fragmented. As important, randomized controlled trials comparing the 3 possible interventions are not yet available.

1. When was the client diagnosed with sleep apnea?

The risk selection process begins with knowing when the actual diagnosis of OSA was made.

2. Has the client undergone a sleep study?

While it is possible to "suspect" the diagnosis of sleep apnea based on history alone, a sleep study is needed to both confirm the diagnosis and determine the severity of the condition. The information gained from a sleep study also impacts the type of treatment for OSA.

3. Does the client currently smoke or consume alcohol?

Cigarette smoking is a risk factor for sleep apnea. Alcohol, especially before sleeping, may precipitate or worsen sleep apnea.

4. What medications is the client taking?

Like alcohol, sedatives (i.e. Valium, Ativan, Xanax, etc.), especially before sleeping, may precipitate or worsen sleep apnea. There is also a likelihood the client may be taking medications for high blood pressure.

5. How is the client's sleep apnea being treated?

The treatment of sleep apnea may be as simple a the "tennis ball" strategy (i.e. a tennis ball is placed behind the client as he or she sleeps on their side to wake them up if they try to sleep on their back). It may be as involved as extensive throat surgery or the use of a special breathing device called CPAP.

IMPORTANT NOTE: The non-surgical treatment of sleep apnea, especially with CPAP, requires a high degree of patient cooperation. It is important to document the degree of patient compliance with their treatment program.

6. Has the client had a follow-up sleep study?

Clients who are diagnosed with OSA requiring treatment (i.e. CPAP) are usually advised to have a follow-up sleep study. However, a large portion of clients are unwilling to undergo a second study

7. Has the client undertaken any lifestyle changes to treat his or her sleep apnea?

Weight loss, exercise, smoking cessation, and reducing alcohol intake all have beneficial effects on sleep apnea. Any of these positive lifestyle changes also have a positive impact on the underwriting outcome.