Question

Mr. Piper is a 53 y/o gentleman who presents today for an annual physical exam. He is accompanied by his wife. He tells you he is doing well with no complaints; however his wife interrupts him saying, “I knew he wouldn’t tell you so that’s why I came. I am worried about him because he wakes me with loud snoring, but worse than that, I think he stops breathing & it’s for a long time! Then he snorts & starts breathing again. I am afraid he is going to die!”

Past medical history: Obesity, HTN, chronic atrial fibrillation (AF), peripheral vascular disease.

Past surgical history: Appendectomy, age 25

Medications: Coumadin, Metoprolol, Diltiazem, Benadryl at hs, Ibuprofen prn pain or h/a

Assessment today

Vital Signs: BP 156/88, HR 89, RR 24, POX 92% RA, Temp 98.6, Weight 228 (103.6 Kg), Height 5’7” BMI

Physical Exam: Neuro A & O x3; Lung sounds clear thru out; Heart sound irregular, no murmur appreciated; Abd large soft, nontender, bowel sounds +; Extremities PP+, scant lower leg edema

The Health Care Provider explains to Mr. Piper & his wife that this sounds like he has developed obstructive sleep apnea (OSA).

Questions to consider:

1. Define apnea & the apnea-hypoapnea index (AHI).
2. How long can apnea occur at one time in a client with OSA?
3. Review the pathophysiology r/t to OSA.
4. In this case what all may have contributed to OSA?
5. Is there any additional history you would want to ask Mr. Piper about?
6. Review the clinical manifestations of OSA.
7. What diagnostic work up will be ordered to confirm the diagnosis of OSA?
8. How is the treatment of OSA determined? And what can the treatment include?

Answer 1

1. Apnea is cessation of breathing for atleast 10secs

Apnea - hypoapnea Apnea-hypopnea index (AHI)

The event rate; the number of apneas plus hypopneas per hour of sleep

-helps classify the severity of the apnea

2. Mild OSA is for 15 secs

Moderate OSA is between 15-20secs

Severe OSA is more than 30secs

3#. Pathophysiology :-

Respiratory drive is normally lower during sleep, with a smaller airway size (like from obesity) and increased airway collapsibility (Nasal obstruction → increased nasal resistance → pressure in pharynx more negative) can lead to apnea

4#. Risk factors for obstructive sleep apnea :-

-Obesity (probably from systemic circulation)

-Male gender

-increasing age (esp middle age)

-endocrine changes

-Upper airway anatomic abnormalities (ex micrognathia)