#1 Jail-Patient Mr. ABC WHO?
Subjective
A patient is a 38 years old male referred for an evaluation of Sleep-Disordered Breathing to R/O OSA
from CC.
Chief Complaint: chronic SOB or gasping for air and headaches when he awakens.
Objective
Ht: 70 in, Wt: 291 lbs, BMI: 41.74, BP: 135/73, RR 14, HR 78, Diaphoretic, Neck: 22 in, ESS: 7, SpO2 98%,
Supine SpO2 97%, Nadir SpO2 60%, COVID19 screen negative on 8/6/2021, SB 5 (Snores, Neck,
Witnessed apneic event, large neck, male), temp: 96.6F, Dx: obesity, tobacco use. Medications:
naproxen, clindamycin, levofloxacin. No sleep medication is taken prior to the study, shackled to bed
frame and accompanied by 2 deputies/Sheriffs. English speaker. Lights off 21:36 & Lights on 03:58 per
request.
1 Pillow used. Bathroom: none. Adverse events: none. Leak issue: changed from N20 (medium) to F20
(large) due to recurring high to excessive leaks. Started with CPAP +5 cmH2O and ended with BPAP
+21/17 cmH2O as an optimal titration with Supine REM included, ~15 mins duration with < AHI 5.
Persisting sweat artifact present with fans blowing directly onto pt.
Assessment
Severe AHI: ~ 131; Primarily obstructive events: apnea > hypopnea
Moderate to Severe snore
Worse on Supine + REM
High risk category of OSA from ESS and SB
EKG before and during study: N/A; sinus rhythm
HR: Tachycardic +/- 100 during diagnostic and split (lights off to lights on)
Plan
Conduct Split sleep study if patient qualifies
Inclusion criteria to Split: AHI > 15 since no comorbidities are present, COVID19 screening test or
vaccination record per protocol.
Mask Fit: Nasal vs Full face
Maintain leak to None-to-acceptable
Viral filter must be used
Mutual understanding of how patient should reach our attention (i.e. bathroom use)
Any urgent/emergent scenario will be notified to PM supervisor and act accordingly per hospital
policy/protocol and notify Medical Director.
Shackle will be used while TIB, so make it most comfortable for the patient as possible to
encourage falling and maintaining asleep
#2 Patient XZY Severe
Subjective
A patient is a 49 years old male referred for an evaluation of Sleep-Disordered Breathing.
CC: loud snoring, witnessed apneic events, large profound neck, and chronic fatigue and daytime
sleepiness.
Objective
Ht: 66 in, Wt: 315 lbs, BMI: 50.7, BP: 142/88, RR 18, HR 96, Diaphoretic, Neck: 20 in, ESS: 16, SpO2 98%,
Nadir SpO2 51%, COVID19 vaccination (checked off), SB 5 (Snores, Neck, Witnessed apneic event, large
neck, male), temp: 96.7F, Dx: morbid obesity and papillary thyroid carcinoma. Medications:
levothyroxine. No sleep medication is taken prior to the study. English speaker. Lights off 22:43 & Lights
on 05:40 per request.
Assessment
AHI = 120; Severe.
Moderate to Severe snore
Worse on Supine + REM
High suspect/risk of OSA (ESS and SB)
Incomplete titration with BPAP 25/21 cmH2O + 6L O2 + High-Fowler
Residual AHI: 69.6 from AHI 120 baseline
SpO2 (Mean-to-Nadir): 68%-to-52%
Prior lights on, SpO2 was in high 70 to 80’s%
Plan
Conduct sleep study: Split
Initiate Split with AHI 15 or more + complete COVID19 vaccination record
Initiate O2 protocol when indicated
Mask Fit: Full face
Maintain leak to None-to-acceptable
Viral filter must be used
Mutual understanding of how patient should reach our attention (i.e. bathroom use)
Any urgent/emergent scenario will be notified to PM supervisor and act accordingly per hospital
policy/protocol and notify Medical Director.
Bonus features of XYZ Severe: