lepsy does not exclude the di agnosis of obstructive sleep apnea hypopnea, as the two con-
ditions may co-occur.
Insomnia disorder. For individuals complaining of difficulty initiating or maintaining
sleep or early-morning awakenings, insomnia disorder can be differen tiated from obstruc-
tive sleep apnea hypopnea by the absence of sn oring and the absence of the history, signs,
and symptoms characteri stic of the latter disorder. However, insomnia and obstructive
sleep apnea hypopnea may coexist, and if so , both disorders may need to be addressed
concurrently to improve sleep.
Panic attacks. Nocturnal panic attacks may include symptoms of gasping or choking
during sleep that may be difficult to distinguish clinically from obst ructive sleep apnea hy-
popnea. However, the lower frequency of episo des, intense autonomic arousal, and lack of
excessive sleepiness differentiate nocturnal pa nic attacks from obstructive sleep apnea hy-
popnea. Polysomnography in individuals with nocturnal panic attacks does not reveal the
typical pattern of apneas or oxygen desaturation characteristic of obstructive sleep apnea
hypopnea. Individuals with obstructive slee p apnea hypopnea do not provide a history of
daytime panic attacks. 
Attention-deficit/hyperactivity disorder. Attention-deficit/hyperact ivity disorder in chil-
dren may include symptoms of inattention, academic impairment, hyperactivity, and in-
ternalizing behaviors, all of which may also  be symptoms of chil dhood obstructive sleep
apnea hypopnea. The presence of other symptoms and signs of childhood obstructive
sleep apnea hypopnea (e.g., labored breathing or snoring during sleep and adenotonsillar