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Abstract: Obstructive sleep apnea, or obstructive sleep apnea hypoventilation syndrome, can cause symptoms such as daytime sleepiness and nighttime snoring. In this case, the patient came to the clinic because of daytime sleepiness and nighttime snoring with elevated blood pressure and morning headache, and was diagnosed with obstructive sleep apnea hypoventilation syndrome after sleep breathing monitoring and other tests. After adjusting his lifestyle and using ventilator therapy together with medication to lower blood pressure, his morning headache and daytime sleepiness were significantly relieved, his snoring disappeared at night, and his blood pressure was controlled stably.
Basic information】Male, 51 years old
Disease Type】Obstructive sleep apnea hypoventilation syndrome
Hospital】Zhejiang Provincial People’s Hospital
Date of Consultation】February 2022
Treatment plan】Take antihypertensive drugs (amlodipine benzoate tablets, Irbesartan tablets), use ventilator therapy, adjust lifestyle
Treatment period】Outpatient follow-up for 2 months
Results】Stable blood pressure, relief of morning headache and daytime sleepiness, disappearance of snoring at night
I. Initial consultation
A 51-year-old Mr. Zhao was taking amlodipine besylate and irbesartan tablets regularly for a long time because of hypertension. When he measured his blood pressure at home, his systolic blood pressure was 135-150 mmHg and diastolic blood pressure was about 85 mmHg. He complained of dry mouth in the morning, frequent headaches, and easy sleepiness during the day, and in recent years, he had a lack of energy and easy forgetfulness. Family members reported that the patient often snored during nighttime sleep and sometimes had prolonged breathing pauses. The patient himself felt that the quality of sleep was not good, and he occasionally had a feeling of breath-holding during sleep, which was initially considered as obstructive sleep apnea hypoventilation syndrome. Initial screening was performed using the Epworth Sleepiness Scale and the STOP-BANG scale, which revealed an ESS score of 13, suggesting a significant decrease in mental clarity, and a STOP-BANG score of 4, suggesting a greater possibility of obstructive sleep apnea hypoventilation syndrome.
II. Treatment history
The patient was recommended to be hospitalized to improve polysomnography monitoring, after which it was confirmed that the sleep apnea hypoventilation index (AHI) was 47.6 and the lowest nocturnal oxygen saturation was 78% with an average of 90%, thus confirming the diagnosis of obstructive sleep apnea hypoventilation syndrome. After the diagnosis was clear, the patient was advised to continue using antihypertensive medications, such as amlodipine benzoate tablets and irbesartan tablets. Pay attention to weight control and choose to sleep on the side as much as possible, while continuous positive pressure ventilation treatment with portable ventilator is available.
III. Treatment effect
After 1 week of treatment with portable home ventilator continuous positive pressure ventilation (CPAP) mode, the patient’s snoring disappeared during nighttime sleep, the feeling of breath-holding improved, and the symptoms of dry mouth and headache in the morning were significantly reduced, and the mental state during the day improved, and he no longer felt drowsy all day as before, and the time of sleepiness decreased. The blood pressure was lower and more stable than before, both in the home self-measurement and in the outpatient follow-up after 2 months.
IV. Notes
We were very happy as the attending physician to see the patient’s blood pressure stabilize, the symptoms of morning headache and daytime sleepiness significantly relieved, and the snoring disappeared at night. The patient was advised to adhere to the ventilator treatment and to read the ventilator memory card regularly to know the treatment effect. At the same time, diet control, proper exercise, regular rest and rest, and avoid alcohol abuse and overexertion to avoid aggravating sleep apnea symptoms are needed. Continue the original regimen of antihypertensive drugs and monitor blood pressure continuously. If it is ideal for several weeks, you can consider reducing the dosage appropriately.
V. Personal insight
Obstructive sleep apnea hypoventilation syndrome is associated with hypertension, cardiac arrhythmias, and cognitive decompensation. Patients often have elevated blood pressure at night, which is difficult to control, and about 30% or more of hypertensive patients have a combination of obstructive sleep apnea hypoventilation syndrome to varying degrees. Therefore, patients who encounter refractory hypertension, obesity or overweight, and tend to doze off during the day need to be alert to this disease. The diagnosis can be clarified by polysomnography or portable multichannel sleep apnea monitor examination. For patients with moderate to severe obstructive sleep apnea hypoventilation syndrome, intervention with a ventilator is recommended to avoid prolonged apnea during sleep.