How Is Sleep Apnea Diagnosed?

Sleep apnea is a condition that can cause you to stop breathing for short time periods while you sleep. Eventually, your breathing restarts—but, the pattern of stopping and restarting could affect your airways and heart health.

Although different types exist, obstructive sleep apnea is the most common. Symptoms of sleep apnea include snoring, waking up in the middle of the night (either gasping for air or needing to use the restroom), and feeling excessively tired in the mornings. 

Because sleep apnea is a condition that happens while you sleep, you may have a hard time noticing symptoms at all. If you or a loved one do notice symptoms, your healthcare provider can use a variety of tests to reach a proper diagnosis. 

Generally, your primary care provider may work with a sleep medicine physician (a doctor who specializes in sleep disorders) if they suspect you have signs of sleep apnea—this may be known as your “care team.” During your appointment, your care team will likely ask you about your symptoms, perform a physical exam, and try one or more testing procedures that can help diagnose sleep apnea.

Medical History and Physical Exam

It’s standard practice for your primary care provider to ask you about your medical history and perform a physical exam at your initial appointment. 

To learn more about your personal and family medical history, symptoms, and lifestyle habits, your provider may ask you:

• Do you snore?
• Do you sleep on your back?
• Do you wake up in the mornings feeling tired or with a headache?
• Do you wake up in the middle of the night?
• Do you have a parent or sibling with a sleep disorder?
• Do you drink alcohol or use tobacco?
• What quality of sleep are you getting?
• What do your exercise and eating habits look like?
• Are there any changes in your life that may be affecting your sleep patterns?

It is also common for your provider to discuss any other health conditions that you have that may increase your risk of developing sleep apnea. These conditions include high blood pressure, obesity, type 2 diabetes, history of stroke, or a heart condition.

Currently, there are no physical exams that exist that help healthcare providers specifically diagnose sleep apnea. But, your healthcare provider will likely:

• Measure your vitals (e.g., blood pressure, heart rate, temperature)
• Take a look inside your mouth and throat for any signs of obstruction, a large tongue or inflamed tonsils 
• Check your weight

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Procedures

Your healthcare provider can use two primary procedures to diagnose you with sleep apnea: a laboratory polysomnography and a home sleep apnea test. After the tests are completed, a sleep medicine physician typically reviews and interprets the results.  

Polysomnography

Healthcare providers consider a polysomnography the gold standard of sleep apnea testing. This is a sleep study that takes place in a sleep laboratory (which is designed to look much like a hotel room) and involves wearing several monitors. A sleep medicine expert may also refer to this test as an “overnight sleep study.”

Your provider may require you to wear one or more of the following monitors while you sleep: 

• A nasal cannula—a thin, flexible plastic that fits inside of your nose— which can measure your breathing and airway pressures
• Bands worn over your chest and abdomen to measure how your body functions and moves as you breathe 
• Pulse oximeter monitor worn on your finger to measure your oxygen levels throughout the night  
• Electrodes placed on your head to measure your brain waves 
• Electrodes placed on your chest to measure your heart rate and rhythm 

A lab technician will be available at the sleep laboratory (but not inside the room) to monitor your breathing, heart rate, oxygen levels, and movements. In addition to measuring how well you breathe, this test will also record how often you wake up at night due to snoring, gasping, or choking.

Laboratory-based testing can be very complete, but it’s common for people who undergo this test to have difficulty sleeping. That’s OK—because several factors such as testing anxiety and being away from your normal bed can contribute to this. 

Home Sleep Apnea Testing 

Home sleep apnea testing has a sensitivity and specificity rate of about 79%—meaning, it accurately diagnoses nearly four out of five people with sleep apnea. While lab testing is the standard, home sleep apnea testing is possible.

Home sleep apnea tests involve applying monitors to yourself. These monitors will check how you’re breathing, the way your airways and heart are functioning, and your oxygen levels throughout the night. However, this form of testing doesn’t measure your leg movements or changes in positioning when you sleep like laboratory testing does.

During the test, a lab technician may also be reachable by phone to assist you with any issues.

Generally, at-home testing is safe for most people. But, if you have a history of heart or lung disease or any other serious conditions, your care team will likely recommend laboratory-based testing to most accurately measure how your breathing affects your organs.

Diagnostic Criteria 

Your care team or other sleep medicine experts will typically diagnose sleep apnea using a measurement called the apnea-hypopnea index (AHI). They calculate this measurement based on your results from laboratory or at-home testing. 

Apnea occurs when you stop breathing during your sleep. Hypopnea occurs when you are breathing, but your oxygen levels drop by at least 4% while you sleep. 

Your healthcare provider will use the AHI to measure whether you have sleep apnea and the severity of your condition. This assessment is based on scores—or, numbers that are measured in events per hour of sleep. Events are incidents when your breathing stops or your oxygen levels significantly lower while sleeping.

The scores for diagnostic criteria come in ranges and these ranges are different for children and adults. Here is a breakdown:

If you or your child receive a diagnosis for sleep apnea, your healthcare provider will consider your AHI results, symptoms, and overall health to determine the treatments that are right for you. 

A Quick Review 

If you or a loved suspect that you have sleep apnea, it’s a good idea to visit your healthcare provider for proper testing and diagnosis. At your appointment, your provider will ask you about your medical history and perform a physical exam. If they think you may have sleep apnea, your provider can either recommend a lab-based or at-home sleep study. 

Your healthcare provider will consider how many times (if any) you stop breathing or breathe less effectively while you’re asleep to make a sleep apnea diagnosis and determine the severity of your condition. Receiving an accurate diagnosis can help your care team figure out a treatment plan that improves your symptoms and overall quality of sleep.