Comorbidities and medical course in a young patient diagnosed with severe obstructive sleep apnea

Abstract

Abstract We present the 6-year evolution of a young patient (32 years at diagnosis), smoker (10 pack years), diagnosed in September 2011 by cardiorespiratory polygraphy with severe obstructive sleep apnea syndrome (OSA)-apnea–hypopnea index (AHI) 82/h, mean SaO2 76%, which associate class II obesity (body mass index [BMI] 37.5 kg/m2), dyslipidemia, hypertension, mixed ventilatory dysfunction with hypoxemia and hypercapnia, pulmonary hypertension, and right bundle branch block. It was administered drug treatment, oxygen therapy, and continuous positive airway pressure (CPAP) with favorable evolution. One year later, we notice a significant improvement in the severity of OSA (AHI 13/h) and significant weight loss (about 24 kg). He was diagnosed with thyroid papillary carcinoma and left laterocervical node metastasis. Total thyroidectomy, treatment with radioactive iodine, and Euthirox replacement were done. In 2013, the patient presents moderate OSA (AHI 25/h) and class I obesity (BMI 31.8 kg/m2). Withdrawal of CPAP on its own initiative and weight gain (BMI 43 kg/m2) causes clinical deterioration in 2014, with diurnal drowsiness, dyspnea at rest, peripheral edema, hypoxemia, and hypercapnia, requiring admission. The cardiorespiratory polygraphic evaluation highlights severe OSA with AHI 84/h. Evolution was favorable with medication, oxygen therapy, and CPAP. Over the next 3 years, the patient continues CPAP treatment at home, but variations in body weight help improve or worsen OSA severity.