One of your pulmonary patients has just been diagnosed with OSA. A home sleep test has already been ordered by their primary care provider, the patient has completed the test, and the results of this sleep study have revealed an AHI of 20 events per hour with significant oxygen desaturations. The patient has symptoms/complaints of daytime fatigue and sleepiness, refractory hypertension, and loud snoring (as noted by their bed partner).
Additional physical characteristics include: a BMI of 35 kg/m2 with documented worsening and refractory hypertension over the past year (the hypertension has not been adequately controlled after a number of antihypertensive medications have been tried, individually and in combo-therapy). Upon inspection, the patient’s tonsils and adenoids are normal sized, but the tongue is enlarged with a Mallampati score of class III. No abnormalities are noted of the facial features or jaw positioning; however, the patient does have a significant history of temporomandibular joint (TMJ) pain.
As a clinician, this patient is seeking your advice in treating their newly diagnosed OSA. It is your job to research four treatment options: CPAP, oral appliance, maxillomandibular advancement surgery, and lastly – hypoglossal nerve stimulation therapy. ( I CHOOSE CPAP)
After conducting your research, the goal is to construct an easy-to-read treatment recommendation for this patient.
Treatment Recommendation and Discussion: Make a final choice for your treatment recommendation. In the Discussion/Evidence section of the assignment, explain why this is the best treatment for the patient and you must take into consideration the patient’s physiologic factors (listed above) when making this decision. You must support your decision by referencing at least one peer-reviewed journal article.
Ensure to address all of the following questions in the Discussion/Evidence section while making a case for your chosen treatment:
A. Is the treatment recommendation a reasonable option for the patient’s AHI and physical characteristics?
B. What are the odds of treatment compliance or success?
C. What can be done to improve their success in compliance? (Education, resources, etc.)
D. Will insurance have an impact on this decision? And will insurance support the treatment recommendation?
E. Are there additional treatments or lifestyle changes that could help improve the patient’s success?
F. Would you direct the patient to seek the advice of a certified sleep physician?