CASE STUDY 8

64 year old woman, loud habitual snorer with observed apneas. Excessive daytime fatigue. Severe acid reflux symptoms. BMI of 26.7. Epworth score of 6.

Dynamic Nasopharyngoscopy

Small velophayngeal aperture, edematous mucosa, moderate lateral collapse with Muller's maneuver, soft palate sags with jaw thrust.

Baseline Oximetry

ODI of 8.3.

Diagnosis - Mild to Moderately Sever OSA.

Treatment - Elevate trunk by 30 degrees with foam wedge. Rhinocort 100 micrograms 1 puff each nostril qhs. Full upper denture does not preclude use of a dental appliance but airway edema and sagging of soft palate with jaw thrust make response to this treatment less predictable.

Response - Improvement in heartburn but Epworth score increases to 9 and feels more tired during the day.

Follow - up - Standard CPAP initiated at a setting of 8.

Oximetry on CPAP of 8

Outcomes - Epworth score remains at 9 but more alert and energetic during the day. ODI reduced to 1.7.

This case demonstrates that CPAP can benefit patients with Mild OSA and should be considered when conservative measures such as body position, and nasal sprays are not effective.

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