CASE STUDY 3

53 year old man, loud habitual snorer, observed apneas, waking up several times a night with a dry throat, increased lethargy, poor short - term memory, close to falling asleep behind the wheel when driving home from work in the evening.

BMI 37.7, neck circumference of 46 cms, Epworth score of 10.

Dynamic Nasopharyngoscopy

Small swollen airway showing marked lateral collapse with Muller's maneuver, soft palate sags and occludes velopharynx during jaw thrust. This last finding indicates that the neuromuscular apparatus of the soft palate has been damaged by snoring.

Baseline Oximetry

Diagnosis - Severe Obstructive Sleep Apnea, ODI of 31.5.

Treatment - Auto - CPAP, pressure of 10. Sleep with trunk elevated to 30 degrees with foam wedge.

Oximetry on CPAP

Treatment Outcomes - Improved energy and alertness. Epworth score of 3. ODI of 9.8.

Compliance monitoring showed nightly use of ~ 6 hours with auto - CPAP triggering 3 - 4 times a night.

After 4 months of treatment with the auto - CPAP he had also achieved a 23 kg weight loss through diet and exercise. His Epworth score remained at 3. The oximetry and dynamic nasopharyngoscopy were repeated.

The nasopharyngoscopy showed the following changes:

• Increase in the lateral dimension of the resting airway
• Continued marked lateral collapse with Muller's maneuver
• Soft palate now elevates with jaw thrust indicating recovery of the neuromuscular function of the palatal muscles

Oximetry on CPAP with Weight Loss

The oximetry showed an increase in the mean oxygen saturation due to the weight loss (that has resulted in an increased lung capacity when supine). The ODI was 8.

With further weight loss and continued use of the CPAP, this patient will eventually have the option of switching to a dental appliance for treatment of his OSA.

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