Sleep Apnea

HISTORY:

‍SnoringDaytime sleepinessWitnessed apnea during sleep for ‍ ‍hoursdays

‍snoring

‍daytime sleepiness

‍fatigue

‍morning headache

‍witnessed apnea during sleep

‍abrupt awakenings accompanied by gasping or choking

‍difficulties in concentration

‍depression

‍irritability

‍difficulty staying asleep

Worsening factors: ‍none

Treatments tried: ‍none, ‍effectiveineffective

Epworth Scale: ‍lowmoderatesevere risk



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Nose: ‍normal

Throat: ‍normalrednessexudate

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Obstructive sleep apnea ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Epworth sleepiness scale

- Polysomnography

- Blood work: ‍CBC, ‍TSH, ‍electrolytes, ‍creatinine, ‍glucose, ‍HbA1C, ‍lipid profile

- ECG

- Chest X-ray

- Pulmonary function tests

- Lifestyle modifications: weight loss, alcohol moderation

- Positional therapy

- Continuous positive airway pressure

- ‍Oral appliances

- ‍Surgical options

- ‍Medications

- Referral to pulmonologist

- Referral to ENT specialist

- Referral to dietitian

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if new symptoms develop such as excessive daytime sleepiness, observed episodes of stopped breathing during sleep, or abrupt awakenings accompanied by gasping or choking