-THIS CONDITION HAS BEEN DOCUMENTED IN UP TO 10% OF MEN OVER AGE 40.

-IT FREQUENTLY AFFLICTS WOMEN AS WELL--PARTICULARLY THOSE WHO ARE OBESE AND/OR POST MENOPAUSAL.

-CHILDREN ALSO CAN DEVELOP SLEEP APNEA--ESPECIALLY IF SUFFERING FROM UPPER AIRWAY COMPROMISE
(ex: large adenoids and tonsils, severe allergic rhinitis or retrognathia).

What were the clues in this case history?

All of the following were consistent with occult sleep apnea--although none could be regarded as diagnostic:

--Waxman was chronically late for office visits.
--He was chronically irritable.
--He seemed mentally sluggish, with a poor memory.
--When Andrews entered the exam room, Waxman's head snapped up because he had already dozed off.
--Part of Waxman's newspaper had fallen on the floor during the time that he was asleep.
--He had the habitus of "an ex-football player, gone to seed". Many men with this body build (stocky, abdominal obesity, broad face, and short, thick neck) will be found to have sleep apnea (although the condition can afflict slender individuals as well).
--Waxman suffered from hypertension. In some series, roughly half of patients with essential hypertension demonstrated sleep apnea.
--He was defensive and prone to denial. Many individuals with sleep apnea do not sense their sleepiness but still recognize that for reasons unclear to them, they are losing their mental capabilities. Such can lead them to fear of loss of employment and and to martial efforts to conceal their impairment.
--Waxman was impotent: a problem commonly found in sleep apnea patients and crucial to realize--particularly since administration of testosterone can make sleep apnea worse.
--He suffered from marital problems...and of major significance was the fact that his wife no longer slept with him. Andrews did not ask why. She had been driven to another bedroom by his terrible snoring: which the patient still may not have admitted to doing, since he never could have heard it himself.

The greatest single problem? Andrews' failure to obtain more history from the patient's wife--which might have occurred in a timely manner if he had thought about this potentially dangerous condition.

Therein lies the tremendous disadvantage experienced by physicians today as regards the detection of sleep apnea. Physicians now suffer from intense time pressures, worse than ever before--and spouses are much less likely to accompany patients to their office visits. With the changes in our economy, most spouses also have full-time jobs.

Despite such, the diagnosis could have been readily made with a minimal expenditure of physician and staff time.

Select from the following menu to continue..

What complications have been associated with this widespread condition?

How can harried physicians in a busy practice setting avoid this frequently encountered pitfall?