History Awake  Attention problems  Daytime sleepiness  Dry mouth  Hyperactive or aggressive behavior  Morning headaches  Poor school performance Sleep  Choking in sleep or witnessed apneas  Frequent awakenings  Hyperextended neck  Nocturnal enuresis  Paradoxical breathing (inspiratory chest movement caused by upper airway obstruction)  Sleep diaphoresis  Snoring

Physical examination General  Failure to thrive  Obesity Head/ear/nose/throat  Adenoid facies  High-arched palate  Macroglossia  Micrognathia  Midfacial hypoplasia  Overbite  Tonsillar hypertrophy (grading does not correlate with severity of obstructive sleep apnea) Cardiovascular  Hypertension  Loud P2 heart sound Extremities  Clubbing (rare)  Edema