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OBSTRUCTIVE SLEEP APNOEA (OSA): CASE STUDIES
One of the physician’s tasks in the sleep disorders clinic is to distinguish between patients with potential sleep apnoea and those with other complaints which adversely affect the quality of sleep. Stress related insomnia, for example, has no place in the laboratory dedicated to sleep related breathing disorders. The following case studies are fairly typical of patient histories which warrant complete evaluation of their symptoms. While they do not accurately reflect the incidence of snoring or OSA in any particular age group or sex, they have been included to demonstrate a diversity of presentations.
A 38 year old travelling salesman had been a heavy snorer for years, aggravated to some extent by the consequences of a broken nose. He was a restless sleeper and often awoke in the morning with a headache. Daytime drowsiness was beginning to affect his attention span and driving competence which eventually led to his falling asleep while driving the car on a long business trip. He was not seriously hurt but the incident prompted investigation of his daytime sleepiness. Examination by his local doctor found him to be moderately overweight for his height and it was noted that he enjoyed five or six cans of beer at night. The doctor advised that his long working hours and drinking habits could explain the worsening symptoms and suggested he lose some weight and take time off for a holiday. Some weeks later he was involved in another near miss driving incident, prompting him to seek advice from another practitioner who referred him to a sleep disorders clinic. Overnight studies confirmed OSA and he began a trial of nasal CPAP which he tolerated well. His quality of sleep and daytime alertness were improved to the extent that he purchased his own CPAP equipment for use both at home and in motel rooms when required to sleep away from home. Weight loss and reduction of alcohol intake improved his condition slightly but not enough to eliminate his dependence on nightly CPAP, a situation he has come to accept as necessary for his wellbeing in the foreseeable future.
Comment: An example of OSA as it is most commonly seen. The patient is middle aged, male, overweight, drinks alcohol at night and has a predisposing factor to airway obstruction (a broken nose). For those who have suffered the symptoms of OSA for years, CPAP offers remarkable relief, an advantage which clearly outweighs the disadvantages and inconvenience associated with its use.
*19/130/5*