Posted by Stuart Holtby on March 30, 1998 at 19:20:59:In Reply to: Hypoxemia posted by Dr. Wexler on March 12, 1998 at 22:01:33:
This man has severe obstructive sleep apnea syndrome and likely has obesity hypoventilation- but you cannot conclude that for sure without knowing his PCO2. He might have any number reasons for his low baseline saturation. We don't have any data on his respiratory status and he might have severe obstructive or restrictive disease (there is a VERY long list).
I assume you are at home in Texas and not in Denver or parts further rarefied.
He needs a respiratory history and physical; a chest xray; a blood gas on room air; spirometry, lung volumes and a diffusing capacity; a hemoglobin or hematocrit.
He should be started on CPAP in a lab because he is at increased risk of severe desaturation in REM sleep, and he should be started in a facility that can titrate onto BiPAP. He might need supplemental oxygen if his baseline saturation remains consistently below 90% when his apnea is well controlled. CO2 monitorring would be nice but is not mandatory- he should have a blood gas in the morning after he has been on CPAP, especially if supplemental oxygen was needed.
Finally he should be considered for therapy with progesterone (eg. MPA 60 mg OD) if his CO2 is elevated over 50 and he has no underlying pulmonary explanation for this, and there are no other contraindications.
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