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Approach to and Evaluation of Sleep Disorders

Shelgikar, Anita, Valanju; Chervin, Ronald

CONTINUUM: Lifelong Learning in Neurology: February 2013 - Volume 19 - Issue 1, Sleep Disorders - p 32–49
doi: 10.1212/01.CON.0000427214.00092.0f
Review Articles

Purpose of Review: This article provides a framework for the clinical assessment of patients with sleep-related complaints and outlines a systematic approach to a sleep-specific history and physical examination, subjective assessment tools, and diagnostic testing modalities.

Recent Findings: Physical examination findings may suggest the presence of a sleep disorder, and obstructive sleep apnea in particular, but the clinical history remains the most important element of the assessment for most sleep problems. While nocturnal polysomnography in a sleep laboratory remains the gold standard for diagnosis of sleep-disordered breathing, out-of-center testing may be considered when the clinician has a high pretest suspicion for obstructive sleep apnea and the patient has no significant cardiopulmonary, neuromuscular, or other sleep disorders.

Summary: Sleep-related symptoms are common in adult and pediatric patients. A comprehensive sleep history, physical examination with detailed evaluation of the head and neck, and judicious use of sleep-specific questionnaires guide the decision to pursue diagnostic testing. Understanding of the benefits and limitations of various diagnostic modalities is important as the spectrum of testing options increases.

Address correspondence to Dr Anita Valanju Shelgikar, Medical School Sleep Disorders Center, C728 Med Inn Building, 1500 East Medical Center Dr, Ann Arbor, MI 48109-0845,

Relationship Disclosure: Dr Shelgikar has received an honorarium from Elsevier for her authorship of a book chapter. Dr Chervin has consulted for Proctor & Gamble and Zansors, LLC; receives compensation for serving on boards from the American Academy of Sleep Medicine, International Pediatric Sleep Association, and the NIH; serves as section editor for and receives royalty payments from UpToDate; receives licensing fees through the University of Michigan from Zansors, LLC; and receives grants from Fisher & Paykel, the NIH, and Philips Respironics.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Shelgikar and Chervin report no disclosures.

Supplemental digital content: Videos accompanying this article are cited in the text as Supplemental Digital Content. Videos may be accessed by clicking on links provided in the HTML, PDF, and iPad versions of this article; the URLs are provided in the print version. Video legends begin on page 48.

© 2013 American Academy of Neurology
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