Which physical findings are significant in the evaluation of insomnia?

Updated: Sep 11, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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If the history suggests sleep apnea, perform a careful head and neck examination. Common anatomic features associated with obstructive sleep apnea/hypopnea syndrome include the following:

  • Large neck size (ie, >17 in. in men)

  • Enlarged tonsils

  • Mallampati airway score of 3 or 4 (see the image below)

  • Low-lying soft palate, particularly in patients with hypertension or cardiac disease

Other features include an enlarged tongue, retrognathia, micrognathia, or a steep mandibular angle. An elevated body mass index (BMI) of 30 kg/m2 or higher is also common.

Mallampati airway scoring. Mallampati airway scoring.

If the patient reports symptoms of restless legs syndrome or any other neurologic disorder, perform a careful neurologic examination. If the patient reports daytime symptoms consistent with any of the medical causes of insomnia, a careful examination of the affected organ system (eg, lungs in chronic obstructive pulmonary disease) may be helpful.

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