Morning headache, dry or sore throat
Enlarged (ie, "kissing") tonsils (3+ to 4+)
Morning confusion
Excessive daytime sleepiness that usually begins during quiet activities (eg, reading, watching television); as the severity worsens, patients begin to feel sleepy during activities that generally require alertness (eg, school, work, driving)
Gasping and choking sensations that arouse the patient from sleep, though in a very low proportion relative to the number of apneas they experience
Witnessed apneas, which often interrupt the snoring and end with a snort
Narrowing of the lateral airway walls: Independent predictor of the presence of obstructive sleep apnea in men but not women
Congestive heart failure
Cognitive deficits; memory and intellectual impairment (short-term memory, concentration)
Sexual dysfunction, including impotence and decreased libido
High-arched hard palate
Insomnia; restless sleep, with patients often experiencing frequent arousals and tossing or turning during the night
Nonrestorative sleep (ie, “waking up as tired as when they went to bed”)
Decreased vigilance
Abnormal (increased) Mallampati score: Identifies risk for difficult tracheal intubation
Daytime fatigue/tiredness
Large degree of overjet
Snoring, usually loud, habitual, and bothersome to others
Nocturia
Hypertension
Systemic arterial hypertension: Present in about 50% of obstructive sleep apnea cases
Gastroesophageal reflux
Retrognathia or micrognathia
