What are the key clinical features to consider when assessing a patient for obstructive sleep apnea?

When assessing a patient for obstructive sleep apnea (OSA), consider the presence of two or more of the following key clinical features: snoring, witnessed apnoeas, unrefreshing sleep, waking headaches, unexplained excessive sleepiness, tiredness or fatigue, nocturia (waking from sleep to urinate), choking during sleep, sleep fragmentation or insomnia, and cognitive dysfunction or memory impairment ¹.

Additionally, be aware of higher prevalence of OSA in patients with certain comorbidities such as obesity or overweight, treatment-resistant hypertension, type 2 diabetes, cardiac arrhythmia (especially atrial fibrillation), stroke or transient ischaemic attack, chronic heart failure, moderate or severe asthma, polycystic ovary syndrome, Down's syndrome, non-arteritic anterior ischaemic optic neuropathy, hypothyroidism, and acromegaly ¹.

Use assessment tools such as the Epworth Sleepiness Scale and the STOP-Bang Questionnaire to evaluate sleepiness and risk, but do not rely solely on the Epworth Sleepiness Scale for referral decisions, as not all patients with OSA have excessive sleepiness ¹.