OSA

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍snoringdaytime sleepinesswitnessed apnea during sleep

Symptoms include:

‍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

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍obesity

‍high neck circumference

‍alcohol

no history of: ‍sleep apnea, ‍congestive heart disease, ‍asthma, ‍rhinitis, ‍adenoid hypertrophy

no use of: ‍sedatives, ‍opioids

no family history of: ‍sleep apnea





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Obstructive sleep apnea ‍likelysuspectedpossible

DDx: obstructive sleep apnea, central sleep apnea, sleep-related hypoventilation disorders, nocturnal asthma, cardiac arrhythmias, GERD, COPD, heart failure, obesity hypoventilation syndrome, narcolepsy, periodic limb movement disorder, restless legs syndrome, primary insomnia, psychiatric disorders, hypothyroidism, medication side effects, substance abuse, upper airway resistance syndrome, tonsillar hypertrophy, adenoidal hypertrophy, nasal obstruction, craniofacial abnormalities





PLAN:

Investigations:

- Epworth sleepiness scale

- Polysomnography

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

- ECG

- Chest X-ray

- Pulmonary function tests

Treatments:

- Lifestyle modifications: weight loss, alcohol moderation

- Positional therapy

- Continuous positive airway pressure

- ‍Oral appliances

- ‍Surgical options

- ‍Medications

Further care:

- 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