Obstructive Sleep Apnea

History:

55 year old, morbidly obese female presented with complaint of shortness of breath for last 2 years. This has increased in severity over the period of last 2 months, now restricting her to minimal activity. There is history of orthopnea and paroxysmal nocturnal dyspnea for the same period. Patient complains that she has not been able to sleep for many months, and it has become impossible for her to lie down flat.

On positive questioning, she further told that, there were apnoic spells during sleep, to start with. She used to snore a lot. Later she became unable to sleep at all. She used to remain drowsy all day long and could not do her routine household work.

She is post menopausal, and there is no history of menorrhagia. There is no history compatible to IHD. She is a non-smoker.

Examination:

Patient is little drowsy but in obvious distress with respiratory rate of more than 30. She is cyanosed (both central and peripheral), with hyperemic palms, and bounding pulse. Heart rate is 45/min, regular. No rise in JVP seen.

Cardiovascular system exam revealed marked bradycardia, loud P2, and probable murmur of Tricuspid Regurgitation.

Respiratory system exam was non-yielding as we were unable to pick up any finding because of thick chest wall.

Labs:

CBC showed microcytic hypochromic anemia.

Liver and Renal function tests were essentially normal.

ECG showed sinus bradycardia, while normal voltages.

ABGs showed a non-compensated type 2 respiratory failure.

QUESTIONS AT WARD ROUND:

1. What are the clinical criteria for Obstructive Sleep Apnea?
2. Can you name five different diseases which may lead to OSA? What could be the predisposing factor in this patient?
3. Why this patient is not having polycythemia?
4. What is the medical management for OSA?
5. What is the difference between CPAP and BiPAP? which one is preferred here?
6. What are the indications for Home Oxygen Therapy? How should we institute it?
7. Name five common complications of OSA?
8. What surgical procedure, if done early, will be most useful in preventing complications?