Otolaryngology & Communication Sciences

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Symptoms of Obstructive Sleep Apnea (OSA)

Major symptoms of sleep apnea include abnormal snoring and excessive sleepiness.

Snoring is often habitual and has occurred for many years.  For most individuals, snoring is often worse while sleeping on the back.  In sleep apnea, snoring, although worse on the back, often occurs in all sleeping positions.

Another major symptom is abnormal sleepiness.  Partners may note choking and "breath holding spells."  Excessive sleepiness may be manifested by a feeling of not being refreshed upon awakening.  There may also be a feeling of sleepiness during the daytime.  It is common that patients are unaware of excessive sleepiness.

Features of Snoring in OSA

Snoring in obstructive sleep apnea may have distinctive features.  These include episodic silence or alternatively increasing loud crescendo snoring followed by decreasingly loud snoring.  This occurs due to increased breathing efforts due to progressive airway collapse relieved with arousal from sleep.

Snoring may be inspiratory (from the act of drawing air into the lungs) or expiratory (from the act of expelling air from the lungs).

Snoring results from vibration and turbulence in the airway.  The degree of blockage across airway segments, palatal length, and palatal stiffness determines the quality and intensity of snoring.

Snoring characteristics change as these variables change between sleep states.  Eighty to 90% of snores originate in vibration of the palate, uvula, and lateral throat tissues.  Snoring is rarely produced by direct vibration of the tongue base or lower throat.

Symptoms of Sleepiness in OSA

Symptoms of sleepiness are highly variable in obstructive sleep apnea.  They are determined by a combination of factors, including the individual normal biologic sleepiness, the time of day, circadian rhythm (biological clock), drugs, alcohol, coexisting disease, age, and sleep habits.

Good sleep habits include ensuring adequate duration of sleep; establishing a regular wake up time; avoiding noise, excessive warmth or cold in the sleep environment; regular exercise, avoidance of caffeine, alcohol, and tobacco.  Improving sleep habits may independently improve the quality of sleep, even when mild sleep disorders are present.

The result of sleep apnea is frequent awakening, which re-establishes breathing, however, this causes restless sleep.

Other commonly reported symptoms can include gastroesophageal reflux (the backflow of stomach contents into the food pipe that connects the stomach to the throat), nocturia (excessive urination at night), enuresis (involuntary discharge of urine after the age of urinary control), impaired memory and concentration, morning headaches and moodiness, decreased sexual drive, and sleepiness.

Typically, the patient is unable to easily identify many of the symptoms of sleep apnea.  For this reason, obtaining information from family members is often essential.

As with any chronic symptom, patients often habituate (get used to) how they feel.  Often patients forget what itis like to be normal.  When getting a history, a friend or relative may give important information.

Epworth Sleepiness Scale Test

For rating yourself in the below activities:

0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing 

Activity Chance of Dozing
Sitting and reading  
Watching TV  
Sitting inactive in a public place (meeting, theater)  
A passenger in a car for 1 hour without a break  
Lying down in the afternoon when circumstances permit  
Sitting and talking to someone  
Sitting quietly after lunch without alcohol  
In a car, while stopped for a few minutes in traffic  
Total (add all of the above scores)  


Scores are distributed as follows:

No OSAS - score of 8.0 +/- 3.5
Mild OSAS - score 11.0 +/- 4.2
Moderate OSAS - score of 13.0 +/- 4.7
Severe OSAS - score of 16.2 +/- 3.3


© 2014 Medical College of Wisconsin
Page Updated 09/10/2014