A 40 year old obese man come to see his physician because he has been suffering from fatigue and day time sleepiness for the previous 2 months. He has been described as a loud snorer and lately he has loss interest in sex. His performance at work is getting poor and he usually suffers from morning headaches.
What is the Differential Diagnosis?
- Obstructive sleep apnea syndrome
- Atypical depression
- Hypothyroidism
- Insufficient sleep
- Obesity hypoventilation syndrome ( Pickwickian syndrome)
- Nacrolepsy.
- Pulmonary hypertension that can lead to Cor pulmonale
- Type II respiratory failure.
What investigations are helpful in the diagnosis of Obstructive sleep apnea?
1. Simple studies e.g pulse oximetry and video recordings are usually all that is needed for the diagnosis.
2. Polysomnography which monitors oxygen saturation, airflow at the nose and mouth, ECG, EMG chest and abdominal wall movements during sleep is diagnostic.
3. The occurrence of 15 or more episodes of apnea or hypopnoea during 1 hr sleep indicates significant sleep apnea.
How will you manage a case of Obstructive sleep Apnea?
1. Educate the patient to reduce excess weight by doing regular physical exercise and avoiding high fat diets.
2. Avoid alcohol and tobacco.
3. CPAP via nasal mask during sleep is effective and recommended by NICE for those with moderate to severe disease.
4. Surgery to relieve pharyngeal obstruction e.g tonsillectomy, uvulopalatopharyngoplasty or tracheotomy are rarely needed in very severe cases.
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