Abstract
A 73-year-old male presents with hypersomnolence and witnessed pauses in breathing during sleep lasting 30–60 seconds. He was diagnosed with obstructive sleep apnea in 1996 and underwent uvulopalatopharyngoplasty (UPPP). His symptoms re-emerged 2 years later. Multiple sleep studies done since then demonstrated Cheyne Stokes breathing. He was treated with continuous positive airway pressure (CPAP), bilevel PAP (with and without backup rate), and/or supplemental oxygen but he continued to have unabated diurnal hypersomnolence and his wife noted incomplete resolution of pauses in breathing. He had history of atrial fibrillation, coronary artery disease, and permanent pacemaker placement. A representative tracing from his diagnostic polysomnogram is shown below (display range 240 seconds). Which of the following treatments is likely to be MOST effective in treating his sleep disordered breathing? Beta blockers Adaptive Servoventilation Automatically adjusting PAP Theophylline Supplemental CO2 Answer B Adaptive servoventilation
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