COMPLEX SLEEP DISORDER BREATHING

Dr. Eric R. Wilde

Disclaimer

No conflicts of interest pertaining to this subject

Case Presentations

Male- 45 yearsBMI- 52ESS-18

History: No cardiac history, smoker ( smokes pkg/ day x 25 years) , works

around welding shop, diabetic. This fellow was sent to the Sleep Clinic because of previous failed Auto- CPAP attempt in community.

Previous Level 3 : AHI- 90 documented desaturation to 36% after Auto CPAP complete AHI- 84 desaturation to 43% .

Presenting complaints:“not sleeping very well” difficulty maintaining sleep, restlessness. PFT’s – mild obstruction and normal diffusing capacityMedications: Advair , Metformin, rosuvastatin, ramipril and

glicazide.

PSG results – Severe hypoventilation with severe obstructive sleep apnea

AHI- 89 desaturation to 55%

CPAP initiated titrated to 20 cm- CPAP worsened the Sleep disorder breathing desaturation to 50% - at this point the CPAP pressure may have tipped the patient into REM but it would not adequately treat the REM desaturation.

BPAP was initiated, ineffective at lower pressures with REM desaturation dropping to 48%

Ending BPAP pressure 27/16 and rate of 16 No Oxygen

Level 3 study to be completed in 4-6 weeks to make sure treatment optimal

Female- 65BMI- 38ESS- 19

Medical History: Right heart failurePresenting complaints: loud snoring, morning headaches,

EDS. Medications: diamox, lasix, heparin PFTs : mild obstruction normal diffusing capacity

Results of PSG

Hypoventilation with severe obstructive sleep apneaRDI- 122 , Desaturation to 58%

CPAP initiated: titrated to 18 but saturations remained about 60%

BPAP initiated : titrated to 24/15 with rate 12 no oxygen . Saturations stabilizing and TCO2 decreasing.

Questions?