PHYSICAL EXAMINATION: ASSESS SITES OF AIRWAY NARROWING AND COLLAPSE
The patient’s health is very important in determining the type and aggressiveness of treatment. For example, in a patient with mild sleep disordered breathing, treatment may not be necessary in a healthy individual, yet treatment would be needed if the patient had signiﬁcant underlying coronary artery disease. Co-morbidities that should be considered include those currently recognized by the Centers for Medicare and Medicaid Services (Table 2), diseases that may be exacerbated by the presence of sleep apnea (ﬁbromyalgia, diabetes, autoimmune disorders, depression, cancer survival), and other abnormalities directly caused by the sleep apnea such as cardiac arrhythmias (brady-tachy arrhythmias, asystole, frequent Premature Ventricular Contractions (PVCs) with couplets or bigeminy, runs of ventricular tachycardia, atrial ﬁbrillation) or nocturnal chest pain. Patients with upper airway resistance syndrome (UARS) also require treatment due to the daytime somnolence caused by this variant of sleep apnea.