CASE STUDY 9

60 year old man, 8 year history of NIDDM requiring escalating doses of Insulin to control (340 units daily at presentation), morbidly obese with BMI of 35.8, chronic heartburn controlled with Ranitidine 150 mg bid. Epworth score of 18.

Dynamic Nasopharyngoscopy

Small swollen airway showing moderate lateral collapse with Muller's maneuver, widens with jaw thrust but soft palate sags.

ODI of 83.2.

Treatment - Auto - CPAP with base pressure of 10.

Outcomes - Epworth score reduced to 8. Insulin requirements reduced to < 240 units/day. Weight stable. CPAP compliance monitoring shows 6 - 7 hours of nightly use with pressures going up to 16 from a base of 10.

ODI of 7.1.

This case illustrates the following:

• Changes to the upper airway caused by snoring are largely reversible once the patient is on adequate treatment
• OSA may be a cause of insulin resistance and diabetics should be warned of the possibility of hypoglycemia once they are on treatment for their OSA