Generally, the most common signs of sleep apnea are a large waist/neck circumference and facial deformities. If sleep apnea is left untreated, signs of for pulmonale, stroke, hypoxemia, and pulmonary hypertension are evident.

• Obese

• Lethargy
• Confusion
• Irritable
• Sitting up and leaning forward to improve diaphragmatic breathing
• Children may not grow at a normal rate

Vital signs are generally within normal limit, but patients with severe disease may have the following vital signs:

• Decreased SPO2
• Tachyapnea
• Tachycardia
• High BP

• Wheeze
• Pleural effusion

• Right ventricular hypertrophy (RVH)
• Left parasternal systolic lift
• 3rd/4th heart sounds and pansystolic murmur of tricuspid regurgitation over right heart
• Split second heart sound with loud pulmonary component
• Systolic ejection murmur with a sharp ejection click over the pulmonary artery
• Diastolic pulmonary regurgitation murmur over the pulmonary artery

• Ascites
• Hepatomegaly
• Large waist circumference

• Cyanosis

• Large neck circumference

• Particularly prominent among men who have a collar size greater than 17 inches and women who have a collar size greater than 16 inches^[1]

• Retrognathia
• Micrognathia
• Lateral peritonsillar narrowing
• Macroglossia
• Tonsillar hypertrophy
• Elongated or enlarged uvula
• A high arched or narrow palate
• Nasal septal deviation
• Nasal polyps
• Increased jugular venous pressure
• Prominent neck and facial veins

• Digital clubbing
• Pedal edema

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