Abstract
An 81-year-old man with severe obstructive sleep apnea (OSA) on auto-titrating bilevel positive airway pressure (BPAP) with 2 LPM nocturnal oxygen presented for an initial sleep evaluation. His device download showed a residual apnea-hypopnea index (AHI) of 5.9 events/h with a clear airway index of 4.3 events/h. The auto-titrating BPAP was changed to a fixed pressure with a goal of decreasing his AHI and managing his hypoxia without oxygen. At follow-up, the patient had a severely elevated AHI and clear airway index. The objective of this report is to enlighten readers about the pathophysiology of hyperventilation, arterial PCO2 (PaCO2) and the apneic threshold.
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