Author Affiliation: Dr Kuna is Chief, Pulmonary, Critical Care, Sleep Section, Philadelphia Veterans Affairs Medical Center; Pulmonary, Allergy and Critical Care Division and Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Philadelphia.
Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
DR BURNS: Mr J is a 54-year-old man with a
history of sleep apnea. He lives in a suburb of Boston with his wife and 2
children, owns a small company, and has managed care insurance.
In 1995, Mr J's wife noted that he stopped breathing at night. Mr J
also recalled that he awoke, on occasion, in the middle of the night with
palpitations. He mentioned this to his primary care physician, Dr M, who referred
him for a sleep study. The study revealed 206 obstructive events, giving an
apnea hypopnea index (AHI) of 36 per hour. He had oxygen desaturation to a
nadir of 74%. Based on these results, his pulmonologist recommended that Mr
J proceed with nasal continuous positive airway pressure (CPAP) titration.
The results of his CPAP study showed that 5 to 6 cm of water pressure eliminated
the obstructive events and oxygen desaturation. Mr J seemed to have some difficulty
falling asleep with the mask, but overall it appeared to be well tolerated
during both rapid eye movement (REM) and non-REM sleep.
Kuna ST. A 54-Year-Old Man With Obstructive Sleep Apnea. JAMA. 2002;288(16):2032-2039. doi:10.1001/jama.288.16.2032