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Clinical Crossroads
Clinician's Corner
October 23/30, 2002

A 54-Year-Old Man With Obstructive Sleep Apnea

Author Affiliations

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.

JAMA. 2002;288(16):2032-2039. doi:10.1001/jama.288.16.2032

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.