Chapter

Case 21

John Stradling, Andrew Stanton, Najib Rahman, Annabel Nickol and Helen Davies

in Oxford Case Histories in Respiratory Medicine

Published on behalf of Oxford University Press

Published in print July 2010 | ISBN: 9780199556373
Published online November 2012 | e-ISBN: 9780191753299 | DOI: http://dx.doi.org/10.1093/med/9780199556373.003.021

Series: Oxford Case Histories

Case 21

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A 52-year-old man with several years of snoring was referred for assessment of possible obstructive sleep apnoea. His wife described characteristic obstructive apnoeas during the night, increasingly frequent over the last year. The snoring had become so bothersome for the patient’s wife that they often slept in separate rooms. The patient awoke feeling refreshed and did not complain of feeling sleepy during the day. He denied sleepiness on prolonged drives, was able to concentrate on reading a book and could watch TV for an hour or so in the evening without falling asleep. He had worked as a commercial airline pilot for the last 15 years and sleepiness had never interfered with his work. He had been successfully treated for essential hypertension for 12 years with bendrofluazide. On examination the patient had retrognathia, a collar size of 16 inches, BMI 25, normal nasal patency and no appreciable abnormality of the oropharynx. Completion of the Epworth sleepiness score (with wife present and agreeing with his account) gave a score of 3/24 (upper limit of normal, 9). A sleep study (Fig. 21.1) demonstrated severe obstructive sleep apnoea with an oxygen desaturation index (ODI >4% desaturations) of 58/h.

Chapter.  1179 words.  Illustrated.

Subjects: Respiratory Medicine and Pulmonology

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