The diagnosis of OSAHS is difficult to establish based on history and physical examination alone. A sleep specialist's prediction of OSAHS based solely on clinical features may be correct in only 60% of cases . As a starting point, OSAHS should be suspected in patients who exhibit loud habitual snoring, witnessed apneas, increased neck circumference (>17 in), BMI greater than 30, and hypertension. The prospect that finding and treating OSAHS in a snorer may improve control of comorbidities, such as hypertension, CHF, or headaches, may provide additional rationale for OSAHS suspicion. Pickwickian phenotype is but one subset of OSAHS and not representative of most OSAHS presentations . Clinical prediction rules provide a consistent template on which to assess OSAHS risk, may help avoid further testing in low-suspicion patients, and may expedite testing for high-risk patients. However, the generalizability of the available formulae are not clear and the probability data must always be tempered by clinical judgment. Strong suspicion of OSAHS should be followed by objective measurement of breathing during sleep using polysomnography.
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