CASE STUDY 7

21 year old Negro woman, complained of excessive daytime sleepiness and waking up frequently at night since childhood. Not known to be a snorer. Suffers chronic rhinorhea. All female members of the family are similarly affected. BMI of 25.1 and Epworth score of 16.

Dynamic Nasopharyngoscopy

Very short oropharynx and narrow velopharyngeal aperture. Note how epiglottis overlaps the uvula and nearly fills the velopharynx. Mild velopharyngeal collapse with Muller's maneuver. Airway dilates with jaw thrust. Nasal passages and nasopharynx were inflamed.

Baseline Oximetry

Compressed view. ODI of 5.3.

Expanded view showing serial desaturation events.

Diagnosis - Mild OSA.

Treatment - Intranasal steroids bid. Nasal congestion resolved and Epworth score was reduced to 5.

This case illustrates the following:

• Obstructive sleep - disordered breathing occurs in women as well as men.
• The correlation between sleepiness and measures of respiratory disturbance is poor.
• Hospital polysomnography would not have helped in her management.

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