Obstructive Sleep Apnea.

A case of SOB with hypothyroidism n obesity. Chief Complaints A 62 yr old male k/c/o CKD + Hypothyridism admitted with breathlessness since 2 days with no associated chest pain, cough, fever. No H/O COPD/ Asthma/ CAD. O/E pt was obese n tachypneic with no signs of heart failure Or COPD but diffuse ronchi b/l.Pt had morbid obesity . Pt also complained of two episodes of black stool but no icterus, Hematemesis, ascites Or splenomegaly. Usg ruled out any liver pathology also stool for occult blood was negative on 3 occasion. Blood investigations showed abnormal lipid profile and fasting blood sugar. Pt had H/o DM but was drug defaulter. CXR and other findings were normal. Since pt was obese with hypothroidism n DM we suspected OSA n so inquired regarding sleep history. Pt wife mentioned snoring, excessive day time sleepiness, restlessness, body ache, night time wakefulness n disturbed sleep. So we planned for polysomnography for which technician did stop bang questionnaire n sleep study. Sleep study was suggestive of severe AHI (apne hyponea index) of 32. Pt was started on CPAP. Pt condition improved gradually n was discharged after 5 days. He was advised for regular use of CPAP during sleep, use of OHA n thyroxine 75 mcg n to come up for follow up. When the pt condition improved after 6 weeks pt was encouraged for wt loss, exercise and tab orlistat 120 mg TDS, Tab atorvastatin 20 mg OD.



Post reflects he is a c/o OSA with high AHI Since pt is kco morbid obesity with high bmi and short neck and h/o snorring and disturbed sleep pattern Yes he needs positive pressure ventilation by c-pep But you have not given his diabetic status though he has CKD and needs to assess DKA as pt is negligent of medication Also we need ecg and 2decho as pt is c/o sob He needs through evaluation

Asthma and COPD can't lead one time.Asthma and COPD are both chronic lung diseases. COPD is mainly due to damage caused by smoking, while asthma is due to an inflammatory reaction. COPD is a progressive disease, while allergic reactions of asthma can be reversible.There are now many guidelines that provide direction for the diagnosis and management of asthma and chronic obstructive pulmonary disease (COPD). However, both diseases are still underdiagnosed (or misdiagnosed) and undertreated.

Good manage the case Type 2 DM ,Hypothyroidism,obesity with CKD-line of treatment is good But you should think about why b/l diffuse ronchi,,ckd usually associated with the b/l crepitus and pleural effusion in case of breathlessness

Lecture on asthma

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