Dr Gillani"s Blog: A 45 year old female comes to your OPD with complaints of fatigue , early morning headache and difficult to concentrate

A 45 year old female comes to your OPD with complaints of fatigue , early morning headache and difficult to concentrate

She also informs you that she gets frequent interruptions in sleep at night time and find it difficult to get up in the morning.

On examination

Her BP is 150 / 90 mmHg

BMI is 35

Weight is 76 kg.

You order routine investigations including a Chest X ray which is given below :

1 .What are the finding on Chest X ray ?

2. What is the most likely Diagnosis?

3. What are the risk factors for this disease?

4 . Which tests and investigations are used to make a diagnosis in this patient?

5. How will you manage this patient?

Answers given in comments section

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(Anonymized data used for teaching purpose only after consent from patient):

1. What are the findings on Chest X ray ? Raised diaphragm on both sides probably due to increased intra abdominal fat causing reduction in lung volumes

Mild cardiac enlargement

Left hilar congestion

Clear lung fields

Clear Costophrenic angles ie no pleural effusion.

2. What is the most likely Diagnosis?

OSA / Obstructive Sleep Apnea Syndrome. Obstructive sleep apnea is a potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep.

There are several types of sleep apnea, but the most common is obstructive sleep apnea. This type of apnea occurs when your throat muscles intermittently relax and block your airway during sleep. A noticeable sign of obstructive sleep apnea is snoring. Increased intra abdominal fat might restrict the diaphragm and make it harder for lungs to expand.

3. What are the risk factors for this disease?

Excess weight , Narrowed airway eg due to enlarged adenoids/ tonsils , High blood pressure (hypertension) , chronic nasal congestion , Smoking , Asthma , Diabetes

4 . Which tests and investigations are used to make a diagnosis in this patient?

To diagnose your condition, your doctor may make an evaluation based on your signs and symptoms, an examination, and tests. Your doctor may refer you to a sleep specialist in a sleep center for further evaluation.

You'll have a physical examination, and your doctor will examine the back of your throat, mouth and nose for extra tissue or abnormalities. Your doctor may measure your neck and waist circumference and check your blood pressure.Tests to detect obstructive sleep apnea include:

Polysomnography. During this sleep study, you're hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep. Home sleep apnea testing. Under certain circumstances, your doctor may provide you with an at-home version of polysomnography to diagnose obstructive sleep apnea. This test usually involves measurement of airflow, breathing patterns and blood oxygen levels, and possibly limb movements and snoring intensity.

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