Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms suggestive of central sleep apnea characterized by a crescendo-decrescendo pattern of respiration (Cheyne-Stokes). Reports include nocturnal dyspnea, orthopnea, excessive daytime sleepiness, and witnessed episodes of apnea. History significant for congestive heart failure (CHF) or recent neurological insult. No evidence of upper airway obstruction.
Clinical Examination Findings
General appearance: Patient appears fatigued. Cardiovascular: S3 gallop, elevated JVP, and peripheral edema noted, consistent with underlying heart failure. Pulmonary: Lungs clear to auscultation, but respiratory pattern shows periodic breathing with alternating hyperpnea and apnea. Neurological: Alert and oriented, no focal deficits.
Treatment Protocol
Primary management focuses on optimizing treatment for underlying congestive heart failure. Initiation of Adaptive Servo-Ventilation (ASV) or CPAP therapy as indicated by polysomnography. Pharmacological management includes titration of ACE inhibitors, beta-blockers, and diuretics. Close monitoring of cardiac function and sleep architecture.