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Misdiagnosis of Sleep apnea

Misdiagnosis of Sleep apnea

Sleep apnea was cited by Reader's Digest as one of the top 10 misdiagnosed diseases. In the article entitled "10 Diseases Doctors Miss", the 10 diseases mentioned were hepatitis C, lupus, celiac disease, hemochromatosis, aneurysm, Lyme disease, hypothyroidism (underactive thyroid), polycystic ovary syndrome (PCOS), chlamydia, and sleep apnea. 1...more about Sleep apnea »

Alternative diagnoses list for Sleep apnea:

For a diagnosis of Sleep apnea, the following list of conditions have been mentioned in sources as possible alternative diagnoses to consider during the diagnostic process for Sleep apnea:

Diseases for which Sleep apnea may be an alternative diagnosis

The other diseases for which Sleep apnea is listed as a possible alternative diagnosis in their lists include:

Sleep apnea: Hidden Causes Misdiagnosed?

Causes of Sleep apnea may include these medical conditions:

Rare Types of Sleep apnea:

Sleep apnea: Medical Mistakes

Related medical mistakes may include:

Sleep apnea: Undiagnosed Conditions

Commonly undiagnosed conditions in related areas may include:

Common Misdiagnoses and Sleep apnea

Mild worm infections undiagnosed in children: Human worm infestations, esp. threadworm, can be overlooked in some cases, because it may cause only mild or even absent symptoms. Although the most common symptoms are anal itch (or vaginal itch), which are obvious in severe cases, milder conditions may fail to be noticed in children. In particular, it may interfere with the child's good night's sleep. Threadworm is a condition to consider in children with symptoms such as bedwetting (enuresis), difficulty sleeping, irritability, or other sleeping symptoms. Visual inspection of the region can often see the threadworms, at night when they are active, but they can also be missed this way, and multiple inspections can be warranted if worms are suspected. See the introduction to threadworm.

Mesenteric adenitis misdiagnosed as appendicitis in children: Because appendicitis is one of the more feared conditions for a child with abdominal pain, it can be over-diagnosed (it can, of course, also fail to be diagnosed with fatal effect). One of the most common misdiagnosed is for children with mesenteric adenitis to be misdiagnosed as appendicitis. Fortunately, thus misdiagnosis is usually less serious than the reverse failure to diagnose appendicitis.

RLS sleep disorder causing night-time leg sensations often misdiagnosed: A common but relatively unknown sleep-related disorder called Restless Leg Syndrome (RLS) is often misdiagnosed. The typical symptoms are night-time tingling, crawling, or burning sensations in the legs, with the irresistable urge to move the legs. This need for leg movement leads to tossing and turning, or getting up out of bed, all of which interferes with the ability to fall asleep. The sufferer then has the typical symptoms of sleep deprivation during the day: fatigue, tiredness, morning headaches, irritability, poor concentration and so on. This condition is sometimes misdiagnosed as other conditions such as ADHD, sleep disorders, other causes of insomnia, or other causes of leg tingling. Many patients also suffer from a related disorder called Periodic limb movement disorder (PLMD), which causes leg spasms or other jerky movements. See introduction to RLS or introduction to PLMD.

Blood pressure cuffs misdiagnose hypertension in children: One known misdiagnosis issue with hyperension, arises in relation to the simple equipment used to test blood pressure. The "cuff" around the arm to measure blood pressure can simply be too small to accurately test a child's blood pressure. This can lead to an incorrect diagnosis of a child with hypertension. The problem even has a name unofficially: "small cuff syndrome". See misdiagnosis of hypertension.

Children with migraine often misdiagnosed: A migraine often fails to be correctly diagnosed in pediatric patients. These patients are not the typical migraine sufferers, but migraines can also occur in children. See misdiagnosis of migraine or introduction to migraine.

Sleep apnea: Rare Types

Rare types of medical disorders and diseases in related medical areas:

Failure To Diagnose Sleep apnea

Failure to diagnose Sleep apnea may be associated with the following:

  • Sleep apnea often remains undiagnosed because patients are hesitant to bring up sleeping problems with their doctor in case it appears trivial or they may fear it is a sign of a serious illness. Also, symptoms of sleeping problems that are volunteered by patients are often ignored by physicians, especially if the patient is seeing the doctor for other problems as well. Patients and doctors often believe that sleeping problems will resolve spontaneously with time
  • As sleep apnea symptoms are most often noticed by a bed partner, someone suffering from sleep apnea may be unaware that they are having breathing problems while they are sleeping. If they don't have a bed partner or their bed partner ignores or doesn't notice their symptoms, then the patient is less likely to realise they may have a sleep disorder and seek treatment for it
  • Women are less likely than men to acknowledge the symptoms of sleep apnea and to seek medical advice. Women also tend to respond differently to sleep problems than men, women will keep going no matter how tired they get whereas men are more likely to increase their sleeping time if they are feeling tired. Women are also more likely to use caffeinated drinks and food to bolster their energy when they feel tired
  • Insomnia is often considered a relatively harmless condition but long-term sleep deprivation can have a significant impact on a person's physical, social and mental health
  • One of the tests used to diagnose sleep apnea is a polysomnography but experts claim that these tests are not readily available to many people. The test is also very expensive so health professionals hesitate in recommending it unless they are reasonably sure the patient has a serious sleep disorder. Also, patients often can't be bothered with going through the lengthy process of a sleep study
  • Untreated sleep apnea can lead to health complications such as heart problems (heart failure, irregular heart beat, heart attack), stroke and high blood pressure. The risk of diabetes and accidents (work-related and vehicular) is also increased
  • Symptoms of sleep apnea such as day time tiredness and irritability are sometimes dismissed by patients and health professionals simply as fatigue due to lifestyle
  • Patients often fail to seek medical advice until a bed partner persistently complains about their sleeping symptoms (e.g. snoring or frequent waking and choking) or they get to a point where they are finding it very difficult to function in their daily routines
  • Even if patients are diagnosed with sleep apnea, compliance with treatment may be difficult as sleeping aids such as CPAP may be very uncomfortable unless trial and error is used to find the most comfortable equipment

Notes On Hidden Causes Of Sleep apnea

The following may be hidden causes of Sleep apnea:

  • Craniofacial structural anomalies may cause sleeping disorders (particularly obstructive sleep apnea). Examples include, small jaw, recessed jaw, underdeveloped upper jaw, cleft palate, large tongue, deviated septum, enlarged adenoids, nasal polyps, nasal mass and enlarged tonsils
  • Sleep apnea may be inherited in some cases
  • Obesity may also contribute to sleep apnea
  • Heart disease (including congestive heart failure) or heart disorders such as atrial fibrillation may be a hidden cause of central sleep apnea
  • High altitudes, strokes, brain tumor and neuromuscular disorders such as LouGehrig's disease, spinal cord injuries and muscular dystrophy
  • Risk factors for sleep apnea are: obesity, increased neck size, narrow airways, high blood pressure, increased age, family history of sleep apnea, smoking and use of tranquilizers, sedatives or alcohol. Males also face a greater risk of sleep apnea than females
  • Conditions that sleep apnea may be associated with include nasopharyngeal cancer, systemic and upper airway inflammation, bulbar poliomyelitis, encephalitis, neurodegenerative diseases and stroke

Notes On Wrong Diagnosis Of Sleep apnea

Wrong diagnosis of Sleep apnea may be associated with the following:

  • Obstructive sleep apnea may be misdiagnosed as a less serious sleeping disorder called insomnia
  • The similarity between symptoms of obstructive sleep apnea and hypothyroidism may lead to misdiagnosis. Hypothyroidism can be a cause of sleeping problems. Common symptoms include fatigue, obesity, depressed mood, impaired concentration and reduced sex drive. Further difficulty arises due to the fact that hypothyroidism may actually be an underlying cause of secondary sleep apnea in some cases
  • Sleep apnea may be misdiagnosed as depression due to the presentation of common symptoms such as reduced concentration, fatigue, irritability and reduced interest in enjoyable activities. Even children with sleep apnea may be misdiagnosed with depression. Diagnosis may be further complicated by the fact that sleep disorders also increase the risk of depression so the two conditions may co-exist
  • Children suffering from the symptoms of undiagnosed sleep apnea may be misdiagnosed as having a learning problem

Complications Of Misdiagnosis Of Sleep apnea

The following may be complications of misdiagnosis of Sleep apnea:

  • Speech problems resulting from obstructive sleep apnea may be misdiagnosed simply as a speech problem rather than the complication of a primary sleep disorder
  • A person with undiagnosed sleep apnea may have problems during or after surgery as the medications used may greatly exacerbate their breathing problems. The condition may be life-threatening during surgery for some patients
  • Children with undiagnosed sleep apnea may be hyperactive and misdiagnosed with ADHD
  • Older, undiagnosed sleep apnea patients who have memory problems, mood swings, urinary problems and impotence may be misdiagnosed with dementia, or simply have their symptoms put down to old age
  • Obese people who suffer from sleep apnea may be diagnosed as having obstructive sleep apnea whereas they may in fact have central sleep apnea which may be exacerbated by increased weight. An accurate diagnosis is important as the two subtypes involve different treatments. Thus great care must be taken to determine the primary cause of the sleeping problem

Other Notes On Misdiagnosis Of Sleep apnea

  • Various types of specialists may be needed to diagnose sleep apnea: ear, nose and throat specialist for obstructive sleep apnea; heart doctor or a neurologist to determine causes of central sleep apnea
  • Sleep apnea patients are more likely to suffer from GERD
  • Waking up choking and abnormal movements during the night and sleepiness during the day are symptoms common to obstructive sleep apnea and nocturnal frontal lobe epilepsy which can lead to misdiagnosis
  • Sleeping problems should always be considered as a differential diagnosis in children with behavioral problems
  • Oximetry is one of the tests that may be used to diagnose sleep apnea - it measures decreases in blood oxygen levels that occurs when breathing is disrupted. However, oxygen levels in young healthy patients with sleep apnea may not be affected to any significant degree by their condition and thus the condition may remain undiagnosed. Conversely, patients with chronic obstructive pulmonary disease may have low oxygen level results which could lead to a misdiagnosis of sleep apnea.

Medical news summaries about misdiagnosis of Sleep apnea:

The following medical news items are relevant to misdiagnosis of Sleep apnea:

Misdiagnosis and Sleep apnea deaths

Sleep apnea is a condition that can possibly be deadly if misdiagnosed...more »

General Misdiagnosis Articles

Read these general articles with an overview of misdiagnosis issues.

About misdiagnosis:

When checking for a misdiagnosis of Sleep apnea or confirming a diagnosis of Sleep apnea, it is useful to consider what other medical conditions might be possible misdiagnoses or other alternative conditions relevant to diagnosis. These alternate diagnoses of Sleep apnea may already have been considered by your doctor or may need to be considered as possible alternative diagnoses or candidates for misdiagnosis of Sleep apnea. For a general overview of misdiagnosis issues for all diseases, see Overview of Misdiagnosis.



Footnotes:
1. Reader's Digest, February 2004, "10 Diseases Doctors Miss", page 120
 

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