Abstract Introduction Obstructive Sleep Apnea (OSA) is a disorder characterized by complete or partial collapse of the upper airway during sleep. Apnea-hypopnea index (AHI) and oxygen desaturation on polysomnogram (PSG), along with symptoms, are used to diagnose and assess treatment success. Both untreated and undertreated OSA are underlying contributors to cardiovascular or neurological conditions, such as stroke, atrial fibrillation, myocardial infarction, and cognitive impairment. Report of case(s) A 79-year-old overweight female (BMI 27 kg/m2) with a medical history of hypertension, hypothyroidism, hyperlipidemia, post-traumatic stress disorder, fibromyalgia, pulmonary hypertension, and OSA on continuous positive airway pressure (CPAP) was admitted to the hospital with new onset atrial fibrillation and pre-syncope. The patient was discharged with an ambulatory cardiac monitor, which detected episodes of supraventricular tachycardia. She was referred to a sleep disorder clinic because of new-onset arrhythmia, fatigue, and mental fogginess. The patient was diagnosed with OSA in 2020 at an out-of-state facility, but endorsed air swallowing and abdominal bloating on CPAP therapy. Her device report showed 90% usage, averaging 6 hours 56 minutes per night, with a residual AHI of 2.3 events/hour, but large mask leaks on most nights. Despite therapy adherence and low residual AHI, the patient continued to report cognitive impairment, fatigue, and palpitations. She underwent a repeat in-lab polysomnography, which demonstrated frequent nocturnal awakenings, nocturnal hypoxemia, and AHI 12 events/hr. The patient was initiated on bilevel positive airway pressure and titrated until minimal apnea-hypopnea events were noted. At follow-up, the patient reported significant improvement in quality of life, daytime alertness, and cognitive function. A Montreal Cognitive Assessment performed before and after optimizing treatment showed improvement of mild cognitive impairment (24/30) to normal cognition (28/30), along with improvements in blood pressure and heart rate control. Conclusion This case demonstrates that obstructive sleep apnea can be undertreated even in the setting of reported adherence and low residual AHI. Persistent fatigue, cognitive, or cardiovascular changes should prompt reassessment of treatment efficacy. This includes evaluation for mask leak, pressure setting, or need for repeat testing. Recognizing inadequately treated OSA as a reversible risk factor is important to improve patient outcomes. Support (if any) None
Thomas et al. (Fri,) studied this question.