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Patient case: Obstructive Sleep Apnoea

Patient case: Obstructive Sleep Apnoea

Discussion

A 38-year-old male presents to the clinic with complaints of loud snoring, frequent awakenings during the night, and daytime sleepiness. His wife reports that he often stops breathing for several seconds during his sleep, which she notices when he’s lying on his back. The patient also complains of feeling fatigued during the day, even after a full night’s sleep. He has a history of obesity, and his BMI is 32 kg/m². He admits to smoking half a pack of cigarettes daily and has recently gained weight. On physical examination, his neck circumference is 17.5 inches, and there are no signs of significant tonsillar hypertrophy or facial abnormalities. Based on these symptoms, obstructive sleep apnea is suspected, and the patient is referred for a sleep study to confirm the diagnosis and assess the severity. Treatment options may include lifestyle changes, weight loss, and a continuous positive airway pressure (CPAP) machine if the diagnosis is confirmed.

Questions
1. What is the most likely diagnosis for this patient?

A) Central Sleep Apnea

B) Obstructive Sleep Apnea

C) Narcolepsy

D) Insomnia

2. Which factor in the patient's history is most strongly associated with obstructive sleep apnea?

A) Age

B) High caffeine intake

C) Obesity

D) Recent surgery

3. What is the next step in confirming the diagnosis of obstructive sleep apnea?

A) Full blood count

B) Polysomnography (sleep study)

C) CT scan of the neck

D) ECG monitoring during sleep

4. What is the first-line treatment for moderate to severe obstructive sleep apnea in adults?

A) Surgery

B) Continuous positive airway pressure (CPAP)

C) Antibiotics

D) Oral corticosteroids

Reveal answers

Answers

1. B) Obstructive Sleep Apnea

The patient's symptoms of loud snoring, frequent awakenings, daytime sleepiness, and episodes of apnea are most consistent with obstructive sleep apnea

2. C) Obesity

Obesity is a significant risk factor for obstructive sleep apnea, and this patient's BMI of 32 kg/m² strongly supports this link.

3. B) Polysomnography (sleep study)

A polysomnography (sleep study) is the gold standard to confirm the diagnosis of obstructive sleep apnea and assess its severity.

4. B) Continuous positive airway pressure (CPAP)

CPAP is the first-line treatment for moderate to severe obstructive sleep apnea, as it helps maintain airway patency during sleep.