OHS and BiPAP Presentation

1. Dr. Eric R. Wilde

2. No conflicts of interest pertaining to this subject

4. Male- 45 years
BMI- 52
ESS-18
History:
No cardiac history, smoker ( smokes pkg/ day x 25 years) , works
around welding shop, diabetic. This fellow was sent to the Sleep
Clinic because of previous failed Auto- CPAP attempt in
community.
Previous Level 3 : AHI- 90 documented desaturation to 36% after
Auto CPAP complete AHI- 84 desaturation to 43% .
Presenting complaints:
“not sleeping very well” difficulty maintaining sleep, restlessness.
PFT’s – mild obstruction and normal diffusing capacity
Medications: Advair , Metformin, rosuvastatin, ramipril and
glicazide.

6. PSG results – Severe hypoventilation with severe obstructive sleep
apnea
AHI- 89 desaturation to 55%
CPAP initiated titrated to 20 cm- CPAP worsened the Sleep disorder
breathing desaturation to 50% - at this point the CPAP pressure
may have tipped the patient into REM but it would not
adequately treat the REM desaturation.
BPAP was initiated, ineffective at lower pressures with REM
desaturation dropping to 48%
Ending BPAP pressure 27/16 and rate of 16 No Oxygen
Level 3 study to be completed in 4-6 weeks to make sure treatment
optimal

7. Female- 65
BMI- 38
ESS- 19
Medical History: Right heart failure
Presenting complaints: loud snoring, morning headaches, EDS.
Medications: diamox, lasix, heparin
PFTs : mild obstruction normal diffusing capacity

9. Results of PSG
Hypoventilation with severe obstructive sleep apnea
RDI- 122 , Desaturation to 58%
CPAP initiated: titrated to 18 but saturations remained about 60%
BPAP initiated : titrated to 24/15 with rate 12 no oxygen . Saturations
stabilizing and TCO2 decreasing.