LOCATION: Outpatient, Hospital

LOCATION: Outpatient, Hospital

PATIENT: Charlie Grove

PHYSICIAN: Gregory Dawson, MD

STUDY PERFORMED: Nocturnal polysomnogram with CPAP (continuous positive airway pressure) titration.

ENTRANCE DIAGNOSIS: Daytime somnolence and obstructive sleep apnea.

The study began at about 2230 hours and continued to about 0530 hours the next morning, for a total of 444 minutes in bed, 271 minutes of sleep, with a sleep latency of 26.5 minutes. He had 275 arousals. He had a heart rate of 80 while awake, 78 while asleep, and it took 2 hours to document the severity of the disease. During that first 2 plus hours, he had a total of 46 respiratory events, for a respiratory disturbance index of 31.7; anything over 5 is considered significant. He had a heart rate of 90 while awake and 78 while asleep. The longest duration of any of these events was 39 seconds. The lowest O2 saturation was 83%, and the lowest heart rate was 70, showing hypoxic and some cardiac effect of these events. He also had 109 myoclonic leg jerks, 97 associated with arousal. He had grade 3 to 4 snoring in all sleep positions, but on his back the snoring was much more significant.

Once it was decided that the patient had severe significant sleep apnea, CPAP was titrated with a nasal mask and was not tolerated; full-face mask not tolerated for more than 5 minutes; BiPAP was also not tolerated. The patient experienced nasal obstruction with a claustrophobic feeling and just could not tolerate the masks.

The patient was also up to the bathroom about five times, which may be a direct effect of the significant obstructive sleep apnea.

During the rest of the night, he had many more events. The patient has obvious severe significant obstructive apnea.

The patient is intolerant of BiPAP and CPAP, so I would recommend referral to ENT for their consideration of a surgical procedure.

SERVICE CODE(S): ________________________________________

ICD-10-CM DX CODE(S): _____________________________________