title: Approach to and evaluation of sleep disorders.
abstract: OBJECTIVE
  This article provides a framework for the clinical assessment of patients with sleep-related complaints and outlines a systematic approach to a sleep-specific history and physical examination, subjective assessment tools, and diagnostic testing modalities.
  
  
  RESULTS
  Physical examination findings may suggest the presence of a sleep disorder, and obstructive sleep apnea in particular, but the clinical history remains the most important element of the assessment for most sleep problems. While nocturnal polysomnography in a sleep laboratory remains the gold standard for diagnosis of sleep-disordered breathing, out-of-center testing may be considered when the clinician has a high pretest suspicion for obstructive sleep apnea and the patient has no significant cardiopulmonary, neuromuscular, or other sleep disorders.
  
  
  CONCLUSIONS
  Sleep-related symptoms are common in adult and pediatric patients. A comprehensive sleep history, physical examination with detailed evaluation of the head and neck, and judicious use of sleep-specific questionnaires guide the decision to pursue diagnostic testing. Understanding of the benefits and limitations of various diagnostic modalities is important as the spectrum of testing options increases.
authors: Medical School Sleep Disorders Center, C728 Med Inn Building, 1500 East Medical Center Dr, Ann Arbor, MI 48109-0845, USA. avalanju@med.umich.edu
authors: Anita Valanju
authors: AV
authors: Shelgikar
authors: Ronald
authors: R
authors: Chervin
mesh_terms: D000818:Animals; D006801:Humans; D010808:Physical Examination; D017286:Polysomnography; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy