CASE STUDY 5

50 year old man with excessive daytime sleepiness that prevented him from accepting a promotion at work, snoring but no observed apneas, BMI of 34.3. Polysomonography at Victoria General Hospital did not show findings consistent with OSA. Mild nocturnal myoclonus was recorded. He was placed on Sinemet with no improvement.

His Epworth score at presentation was 19. Patients with clinically significant nocturnal myoclonus have not been reported to have Epworth scores higher than 16.

Dynamic Nasopharyngoscopy

Shallow velopharynx and hypopharynx, moderate lateral collapse of velopharynx with Muller's maneuver, marked collapse of hypopharynx with Muller's maneuver. However, the airway did not occlude at any level.

Diagnosis - Upper Airway Resistance Syndrome

Treatment - Standard CPAP with pressure of 8. Sinemet was discontinued.

Treatment Outcomes - Epworth score of 5 while on CPAP. Increased energy and alertness during the day.

This case illustrates 2 important points:

• The gold standard for diagnosing Obstructive Sleep - Disordered Breathing is the patient's response to treatment, not polysomnography.
• The incidental finding of nocturnal myoclonus on polysomnography can be misleading and result in inappropriate treatment.

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