Posted by Strohl on March 03, 2003 at 19:33:50:In Reply to: Case H3.98 posted by Stuart Holtby MD ABSM on March 03, 1998 at 19:33:24:
Education of the patient and family of the dangerso of drowsiness and any applicable state law on reporting is a first step. Discussion of work and reducing risk until treatment is instituted. There may be co-existing sleep disorders but there is little further history. Thyroid functon tests are indicated in this young age onset. Mouth leak that prevent bilevel titration indicates velopalatal incompetance or obstruction below the tongue. Surgical evaluation of the upper airway is indicated with an idea that in the absence of an antomic deficit there is a need to perform tracheostomy or use a tracheal catheter (no consensus on this as yet as a first line therapy but there are case collections).