Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic daytime hypersomnolence, morning headaches, and exertional dyspnea. History significant for morbid obesity (BMI >30 kg/m²) and documented sleep-disordered breathing. Reports snoring, witnessed apneas, and unrefreshing sleep. No history of primary lung disease or neuromuscular disorders.
Clinical Examination Findings
General: Morbidly obese, BMI [X] kg/m². HEENT: Mallampati score [X], neck circumference [X] cm. Respiratory: Breath sounds diminished at bases, no wheezing or crackles. Cardiovascular: Regular rate and rhythm, no murmurs, no peripheral edema. Neurological: Alert and oriented, no focal deficits.
Treatment Protocol
Initiate PAP therapy (CPAP or BiPAP) to address nocturnal hypoventilation. Weight loss counseling and referral to bariatric specialist. Optimize management of comorbid conditions (e.g., HTN, DM). Avoid sedatives and alcohol. Monitor ABG for persistent hypercapnia (PaCO2 >45 mmHg).