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Pulmonary, Critical Care, and Sleep Pearls |

A 43-Year-Old Man With Daytime Sleepiness and a Heart Murmur

Christian M. Horvath, MD; Stephan Zbinden, MD; Sebastian R. Ott, MD; Anne-Kathrin Brill, MD
Author and Funding Information

aDepartment of Pulmonary Medicine, University Hospital and University of Bern, Bern, Switzerland

bDepartment of Cardiology, University Hospital and University of Bern, Bern, Switzerland

CORRESPONDENCE TO: Christian M. Horvath, MD, Department of Pulmonary Medicine, University Hospital and University of Bern, Freiburgstrasse 4, CH-3010 Bern, Switzerland


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4):e117-e120. doi:10.1016/j.chest.2016.03.039
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A 43-year-old man was referred to our tertiary sleep center for the initiation of sleep apnea treatment. A prior diagnostic overnight polysomnography (Fig 1) had revealed an apnea-hypopnea index (AHI) of 22/h of sleep. The apneas were predominantly central (central AHI, 18.2/h; obstructive AHI, 3.8/h), more pronounced in the supine position (AHI supine, 36.6/h; AHI nonsupine, 11/h) and during non-rapid eye movement (non-REM) sleep (REM, 15.8/h; non-REM, 23.5/h). A continuous positive airway pressure (CPAP) trial in an outpatient setting had failed, as the fixed CPAP of 11 cm H2O was not tolerated by the patient because of a feeling of lightheadedness when wearing the mask. At referral, the patient complained about falling asleep in front of the computer in the afternoons despite regular bedtimes and 7 to 8 h of sleep per night. His Epworth Sleepiness Scale score was 11. He had no significant past history including cardiopulmonary disease. He was not taking any medication but had noticed a slow decline in general physical performance in the last year, with dyspnea (New York Heart Association class I) after running distances of 1 to 2 km. He had never experienced syncope. His family history was unremarkable.

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