One of the factor in apnea is the horizontal position we assume during sleep, which can lead to narrowing of the air passage. The breathing tube collapses somewhat because of the weight of the body pressing down from above, and it is further obstructed to a degree because the tongue moves from its usual waking position to a position farther back in the throat. Also, during the night the coughing mechanism is somewhat suppressed, and the lungs are less able to clear themselves of secretions. All of these slowdowns in breathing function are normal and pose no threat to the majority of people. When complicated by other factors, however, they can result in OSA.
Results of the physical examination of an apnea victim are often relatively normal. I may, and often do, find elevated blood pressure, or I may notice that the mouth and pharynx are smaller than normal or “crowded” due to some kind of unusual structural formation. On listening to the neck I may hear stridor—the harsh, high-pitched sound associated with obstruction of the larynx. In cases where the heart has been affected, I may detect signs of right ventricular failure, such as distension of the jugular vein or swelling of the ankles. Analysis of gasses in the blood may reveal a high level of carbon dioxide; if so, I will want to rule out some other form of lung disease by ordering further pulmonary tests.
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