Daytime Sleepiness in a 37-year-old male patient who was previously well-managed!
A 37-year-old male, a known case of Narcolepsy Type 2 since he was 22 years old, presented to the outpatient clinic with complaints of worsening daytime sleepiness.
Since his early 20s, he had been taking Modafinil 200 mg twice a day. Up until 3-4 years back, the patient had good control over his sleep; however, for the past 3 to 4years, his symptoms had gradually worsened. The patient had no complaints of cataplexy, sleep paralysis, hypnagogic and hypnopompic hallucinations, vivid dreams, or nightmares. His Epworth Sleepiness Score (ESS) is 16.
The patient usually had an 8-hour sleep at night. His sleep schedule was quite regular, and he consumed only 1 cup of coffee per day. Moreover, he rarely drank alcohol. His work schedule was regular with daytime work hours. There had been no change in his work routine during the last 4 to 5 years.
His past medical, psychiatric, and social history was unremarkable. However, he gained 20 lbs in the past 4 years.
Upon inquiring, his bed partner reported that in the last few years, the patient had moderate snoring, but there were no episodes of apnea, periodic limb movements (PLMs), or parasomnias.
On physical examination, his BMI was 34.8. Additionally, his airway examination revealed oropharyngeal crowding with Mallampati score of 4. The rest of the examination was unremarkable. افضل طريقة للعب الروليت
The patient underwent a repeat polysomnogram to compare the results with the initial sleep study.
Diagnosis:
On the basis of the polysomnogram results, the doctors diagnosed him with new-onset Obstructive Sleep Apnea.
The doctors offered him multiple management options, including positive airway pressure (PAP) therapy, mandibular advancement device (MAD), and surgical options. افضل موقع مراهنات كرة القدم However, they mutually decided to start him on AutoPAP at a pressure of 5-15 cm H2O.
Moreover, the doctors counseled him regarding weight loss and advised him to continue Modafinil 200 mg twice a day.
At the 2-month follow-up, the patient had shown considerable improvement. His ESS score improved to 10. the doctors continued his treatment since he was happy with the symptomatic improvement.
Reference:
Kogan D, Ratarasarn K (2018) Well-Controlled Narcolepsy Patient Sleepy Again. Int J Respir Pulm Med 5:090. doi.org/10.23937/2378-3516/1410090
