1. Vital signs. Is heart rate normal for age and regular? Is there an absence of breathing movements? Are there pauses or irregularities in respiration? Is respiratory effort effective? What is the oxygen saturation, and is it maintained in the normal range?
2. General appearance. Is patient alert and vigorous or lethargic? Any obvious deformities?
3. Growth parameters. Rarely, in severe cases of OSAS, failure to thrive may be evident. Obesity, however, is much more common.
4. HEENT. Evaluate for rhinitis, adenotonsillar hypertrophy, and polyposis. Check for retinal hemorrhages.
5. Cardiopulmonary findings. Check perfusion and abnormal sounds (eg, murmurs, rales, wheezing). Pectus excavatum suggests prolonged or severe upper airway obstruction, or both. Cor pulmonale is rarely associated with OSAS.
6. Neuromuscular exam. Assess tone, cranial nerves, and deep tendon reflexes.
7. Skin. Any signs of trauma or poor perfusion?
B. Laboratory Data. Laboratory investigation should be guided by findings from history and physical exam. Bedside observation of snoring, labored breathing, or obstructed breaths with or without oxyhemoglobin desaturation can be highly suggestive of OSAS.
1. CBC. Evidence of infection or anemia?
2. Serum electrolytes. Evidence of acidosis or electrolyte imbalance?
3. Cultures as indicated. ALTE may be a manifestation of bacterial or viral infection, particularly RSV.
4. Metabolic studies. See Chapter 66, Metabolic Diseases, p. 301.
C. Radiographic and Other Studies
1. Chest x-ray. Can provide evidence of infection, congenital heart disease or aspiration.
2. Anteroposterior (AP) and lateral neck x-rays. Assess patency of airway.
3. Barium swallow. Useful in patients with dysphagia or GERD.
4. ECG. Can identify congenital heart disease.
5. EEG. Can identify seizure disorders.
6. Multichannel pneumocardiogram and polysomnogram.
Assesses respiratory control and adequacy of gas exchange.
7. pH probe. Used to evaluate for GERD. Often useful when performed with multichannel pneumocardiogram.
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