This article provides step-by-step instructions on how to conduct a Sleep Apnea Exam for Dandy's Sleep Program to identify signs of sleep apnea. It covers what to look for and questions to ask.
All the information below are possible signs and symptoms of sleep apnea. A sleep test is required to determine and diagnose sleep apnea.
Step 1: Watch for visible signs during routine exams
Incorporate a quick airway and obstructive sleep apnea (OSA) screen into every routine and new-patient exam. The following can be observed during a standard intraoral and extraoral evaluation.
Intraoral observations
| Observation | Why it may indicate OSA |
|---|---|
| Scalloped tongue | Suggests an enlarged tongue and/or a tongue that is pressing against the teeth in a crowded oral space — associated with airway narrowing. |
| Excessive tooth wear, attrition, or fractured/worn restorations | Bruxism and clenching frequently co-occur with OSA; grinding can be the body's response to airway obstruction during sleep. |
| High, narrow (vaulted) palate | Reduced oral volume and nasal airway space. |
| Enlarged tongue (macroglossia) | Physically crowds the airway. |
| Enlarged tonsils or a long/thick soft palate and uvula | Directly narrows the oropharyngeal airway. |
| Dental erosion on lingual/palatal surfaces | May reflect reflux (GERD), which commonly coexists with OSA. |
| Signs of chronic mouth breathing and xerostomia (dry mouth) | Associated with nasal obstruction and open-mouth sleep. |
| Redness/edema of the soft palate or uvula | Chronic vibration from snoring can cause irritation. |
Extraoral / general observations
| Observation | Why it may indicate OSA |
|---|---|
| Recessed (retrognathic) or small lower jaw; micrognathia | Reduced posterior airway space; the tongue base sits further back. |
| Large neck circumference (roughly >17 in / 43 cm in men, >16 in / 41 cm in women) | Strong physical risk factor for airway collapse. |
| Elevated BMI / obesity | A leading OSA risk factor. |
| Nasal obstruction signs (deviated septum, enlarged turbinates) | Contributes to mouth breathing and airway resistance. |
| General airway concerns / narrowed airway on visual assessment | A crowded or restricted airway raises overall suspicion. |
Step 2: Ask simple screening questions
When one or more visible signs are present, follow up with a few plain-language questions. Below are common questions paired with the answers that should raise suspicion.
| Screening question | Answer that may indicate OSA |
|---|---|
| "Has anyone ever told you that you snore?" | Yes — especially loud, habitual, nightly snoring. |
| "Do you wake up feeling tired, even after a full night's sleep?" | Yes — unrefreshing sleep is a hallmark symptom. |
| "Has anyone ever seen you stop breathing, gasp, or choke during sleep?" | Yes — witnessed pauses in breathing are one of the strongest indicators. |
| "Do you feel very sleepy during the day, or fall asleep when you don't intend to (watching TV, driving, in meetings)?" | Yes — excessive daytime sleepiness. |
| "Do you often wake up with headaches in the morning?" | Yes — morning headaches are commonly associated with OSA. |
| "Do you wake up more than once a night to use the bathroom?" | Yes — frequent nighttime urination (nocturia) can accompany OSA. |
| "Do you wake up with a dry mouth or sore throat?" | Yes — suggests open-mouth sleep and airway effort. |
| "Do you grind or clench your teeth, or has a partner heard grinding at night?" | Yes — bruxism often coexists with OSA. |
| "Do you have high blood pressure, diabetes, or heart problems?" | Yes — these conditions are strongly linked to OSA. |
Step 3: Know when to suspect OSA and refer
Suspicion should rise as findings accumulate. No single sign is diagnostic, but the following patterns warrant a conversation and a referral:
- Multiple visible signs (e.g., scalloped tongue + tooth wear + recessed jaw + crowded airway) appearing together.
- Witnessed apneas reported by the patient or their partner (a strong red flag on its own, even with few other findings).
- Loud habitual snoring plus unrefreshing sleep or daytime sleepiness.
- Multiple risk factors stacking up — obesity, large neck, hypertension, older age, male sex, retrognathia.
Step 4: Sleep Test
When OSA is suspected, explain to the patient in plain terms what you have observed and why it matters — untreated OSA is associated with serious health risks such as high blood pressure, heart disease, stroke, and daytime accidents.
- Offer to provide the patient a complimentary at-home sleep test (HST), for Dandy's Sleep Team to coordinate with the Patient, Insurance and Physician.