Louna Aldreihi

Louna Aldreihi

Louna Aldreihi

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Sleep Laboratory

Diagnosis and Treatment of Obstructive Sleep Apnea (OSA) in a Sleep Laboratory

Patient Profile
  • Name: Mr. A, 48-year-old male 
  • Occupation: Office worker 
  • Medical History: Hypertension, obesity (overweight) (BMI: 35), no previous history of sleep disorders. 
  • Presenting Complaint: Excessive daytime sleepiness, loud snoring, and frequent waking at night. 
Case History

Mr. A has been experiencing persistent fatigue and poor quality of sleep for the past 2 years. He reports that his partner often complains about his loud snoring and gasping for breath during sleep. Despite feeling exhausted, he has trouble staying asleep throughout the night. During the day, he often struggles with concentration at work and has had several near-miss incidents while driving. 

Given his history of snoring, excessive daytime sleepiness his primary care doctor suspects a sleep disorder and refers him for a sleep study. 

Step 1: Evaluation

Before undergoing the sleep study, Mr. A fills out questionnaires, including the Epworth Sleepiness Scale, which measures daytime sleepiness. His score indicates a high level of daytime sleepiness, suggesting the possibility of a sleep disorder. 

Physical Exam: 

  • Obesity (BMI: 35) 
  • Neck circumference (43 cm), which can be a risk factor for obstructive sleep apnea. 
  • Mild hypertension (Blood Pressure: 145/90 mmHg). 
  • Examination of the airways: some enlargement of the tonsils and uvula, which could contribute to airway obstruction during sleep. 
Step 2: Sleep Study (Polysomnography)

Mr. A is admitted to the sleep laboratory for polysomnography, a comprehensive overnight sleep study that monitors various parameters while he sleeps: 

  • EEG (electroencephalogram) to measure brain waves 
  • EMG (electromyogram) for muscle activity  
  • ECG (electrocardiogram) for heart activity 
  • Pulse oximetry to monitor oxygen levels 
  • Airflow sensors to monitor breathing patterns 
Step 3: Findings from the Sleep Study

The sleep study reveals the following key findings: 

  • Apnea-Hypopnea Index (AHI): 28 events per hour (moderate sleep apnea). 
  • Frequent apneas and hypopneas: Mr. A experiences obstructive (airway blockage) apneas (lack of breathing), with a significant drop in oxygen saturation during these events. 
  • Snoring: Loud snoring is documented along with intermittent airway obstruction mostly during REM sleep and when laying on his back. 
  • Sleep fragmentation: Frequent awakenings throughout the night, particularly during REM sleep. 
Step 4: Diagnosis

Based on the findings from the sleep study, Mr. A is diagnosed with Obstructive Sleep Apnea (OSA), characterized by intermittent obstruction of the upper airway during sleep, leading to drops in oxygen levels and disrupted sleep. 

Step 5: Treatment Plan

The treatment plan for Mr. A includes the following: 

  1. CPAP Therapy (Continuous Positive Airway Pressure): CPAP machine is prescribed to keep his airways open during sleep by delivering a constant stream of air. Mr. A is educated on how to use the device effectively. 
  2. Lifestyle Modifications: 
    Weight Loss: A referral to a nutritionist for a weight management can improve sleep apnea symptoms. 
    Sleep Hygiene: Recommendations to improve sleep quality, such as maintaining a regular sleep schedule, avoiding alcohol, and sleeping on his side. 
  3. Follow-up: Regular follow-ups to assess the effectiveness of the CPAP therapy and monitor for any side effects. 
Step 6: Outcome

After 3 months of using the CPAP device, Mr. A reports significant improvements: 

  • Better sleep quality: He sleeps through the night without frequent awakenings. 
  • Reduced daytime sleepiness: His Epworth Sleepiness Scale score decreases, and he feels more alert during the day. 
  • Weight loss: With dietary changes and regular exercise (which became possible with more energy over the day), he has lost 5 kg (11 lbs), which helps reduce the therapy pressure needed to keep his airways open during sleep. 
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Discussion

This case highlights the importance of diagnosing and treating Obstructive Sleep Apnea (OSA), a common condition that significantly affects quality of life. Airway Pressure Therapy is the most common treatment for OSA and, when combined with lifestyle modifications, can greatly improve patient outcomes. 

This case study also underscores the relationship between overweight and sleep apnea, emphasizing the need for weight management as a key part of treatment.  
Regular follow-ups in a sleep clinic ensure that patients like Mr. A receive the support needed to manage their condition effectively.