Obstructive Sleep Apnea

Abstract

Abstract. A 43-year-old man presents with heavy snoring; his bed partner reports that he sometimes stops breathing while he sleeps. He admits to feeling sleepy at times when he drives, although he has not had any motor vehicle accidents. He has hypertension that is controlled by medication but is otherwise healthy. Physical examination reveals that he is overweight (body-mass index [the weight in kilograms divided by the square of the height in meters], 32.7) and has a large neck circumference (46 cm). How should this patient be evaluated and treated?—Flemons WW. Obstructive sleep apnea. N Engl J Med. 2002;347:498–504. Comment. Clinicians are frequently faced with patients who have some form of breathing disorder. During the last decade or so, understanding of the importance of sleep/wake disturbances and their relationship to cardiovascular disease has increased dramatically. Because we now understand that this is a treatable disorder with multiple modalities, we should be very cognizant of the possibility that our patients suffer from obstructive sleep apnea. This article presented in the New England Journal of Medicine is a case vignette, which gives an illustrative report on what is now recognized as a fairly common entity in clinical practice. It is reported in a format that clinicians will find very helpful. Flemons defines the clinical problem and then goes on to discuss the presentation and the modalities available for diagnostic utility in this setting. He delineates methods of treatment from the most benign, noninterventional modality all the way up to the surgical approach. The author presents a copious amount of material that is well referenced and can serve as an excellent resource for cardiovascular clinicians, who are very often faced with this entity. While sleep and respiratory problems are not unique to patients with heart failure, they are frequently concomitant issues. Given this set of circumstances, this article is a “must-read.” It will educate the non-sleep specialists and bring them up to date on a very important malady.