Obstructive sleep apnea (OSA), a common form of SDB, has a high and rising prevalence in the general adult population. The prevalence of OSA in adults is estimated to be 6%, 75% of whom remain undiagnosed. OSA has been independently linked to specific cardiovascular outcomes and all-cause mortality. Treatment of OSA may represent a novel target to reduce cardiovascular health outcomes.1 By early simptom indentification, the nurse can contribute to a timely diagnostics and treatment of cardiovascular and pulmonary patients.

A case report of a patient with the SDB

Andreja Šajnić1, Marina Pavletić2, Slavica Šepec1, Ana Ljubas2

1University Hospital Center Zagreb, Clinic for Pulmonary Diseases Jordanovac, Croatia.

2University Hospital Center Zagreb, Clinic for Heart and Blood Vessels, Croatia.

Diagnosis and Management

The patient was admitted in the ICU due to severe cardio-respiratory condition. ICU management of the patient: prophylaxis with low molecular weight heparin, ACE inhibitors in low doses, venipuncture due to the secondary polycythemia, oxygen therapy, non-invasive mechanical ventilation (NPPV). After stabilization NPPV is replaced with BiPAP device and oxygen therapy 1L/min. 10 days after admission patient successfully applied APAP device without oxygen and SaO2 was within normal range. Recommended therapy for the patient was the application of APAP device.

Blood results SE 5 E 6.66 Hb 199 Htc 0.61 MCV 95 1 day: L 7.2 T 215 GUK 7.1 urate 548 CRP 20

X-ray of the heart and lungs: emphysematous chest, hyperinflation parenchyma with flattened diaphragm, both sides highlighted inflammatory, myopathic heart with large pulmonary arteries.

44 years old male routinely admitted in September 2012, in the Clinic for Pulmonary Diseases, due to polysomnography (PSG) testing. The past 15 years increased snoring, according to the wife stops breathing during sleep, ten years is increasingly sleepy during the day, the last three years falling asleep while driving (a year before a car accident because he fell asleep during the ride) . Epworth sleepiness scale: 24. Conscious, in contact, movable, eupnoic at rest, central cyanosis. BP 115/75mmHg, c/p 108, RR 16, afebrile.

We bring you the results before and after the use of PAP devices for a period of three to six months

ABG after 3 months: pH 7.40 PaCO2 47 PaO2 82 HCO3 28 BE 4 SaO2 96%

Spirometry after 3 months: FEV1 81% FVC 84% Tiff. 73.4

Spirometry: restrictions smaller degree FEV1 54% FVC 59% Tiff. 69.1, salbutamol bronchodilator test negative.

After 3 months: Intrathoracic findings were improved due to a better tone of the heart.

ABG analysis 1 day: pH 7.39 PaCO2 63 PaO2 43 HCO3 37 BE 12 SaO2 77%

Blood results SE 14 E 4.38 Hb 129 Htc 0.38 MCV 86 after 3 months: L 4.1 T 226 GUK 6.3 urate 342 CRP 1.9

ECG: s. tachycardia 100/min, right el. axis, P-pulmonale, incomplete right bundle branch block, right ventricular hypertrophy Echocardiography: The full findings showed significant pulmonary hypertension. LV-EF is estimated 40-45%.

Echocardiography after 6 months: Indirect signs of pulmonary hypertension of mild degree: LV-EF is estimated 60%.

•PSG testing in stable clinical condition: BMI 40.1 AHI 69.3 AI 44.2 HI 25.1 average level SaO2 in wakefulness 95%, NREM 78%, REM 54%, the lowest level SaO2 31%. Arousal index 46.9. •PSG testing with the APAP device and therapeutic pressure (hPa) 10: AHI 13 AI 2.8 HI 10.2 average level SaO2 in wakefulness 93%, NREM 91%, REM 92%, the lowest level SaO2 83%. Arousal index 18.2.

•PSG testing with the APAP device and hPa 14 after twelve months:BMI 33.69 AHI 3.8 AI 3.8 HI 0.0 average level SaO2 in wakefulness 97%, NREM 97%, REM 97%, the lowest level SaO2 94%. Arousal index 12.0 APAP devices number used days: 348 (100%), average hours of use: 7h 17min Epworth sleepiness scale: 0

A case report of a patient with the sleep-disordered breathing (SDB) and developed severe cardio-respiratory

condition, treatment, and outcome.

Conclusion

We present data showing improvement in the health status of a patient who was admitted to our clinic due to severe cardio-respiratory condition. A multidisciplinary approach to the patient is monitored and treated in hospital and brought in clinically stability. Control examinations indicate the incredible recovery cardio-respiratory system, due to long-term use of PAP therapy. Recognizing SDB patients and adequate treatment can reduce the incidence of specific cardiovascular and pulmonary outcomes and all-cause mortality.

EuroHeartCare 2015 Dubrovnik

Sunday 14 - Monday 15 June 2015

References

1. Selim, B., Won, C., Yaggi, H. K. Cardiovascular Consequences Of Sleep Apnea. Clin Chest Med. 2010; 31: 203 – 220