Case history
Case history
A 52-year-old woman with a history of chronic obesity (BMI = 38 kg/m²) presents with a 2-week history of increasing shortness of breath and lower-extremity swelling. In addition, the patient reports increasing daytime sleepiness and morning headaches. Vital signs are significant for a pulse oximetry reading of 86% on room air. Physical examination reveals a small, crowded oropharynx; an enlarged neck circumference (48 cm); an increased P2 on cardiac auscultation; an enlarged abdomen; and 3+ lower-extremity oedema. Basic laboratory investigations are remarkable for an elevated serum bicarbonate of 32 mmol/L (32 mEq/L). An arterial blood gas is obtained revealing a pH of 7.28, PaCO₂ of 68 mmHg, PaO₂ of 56 mmHg, and SaO₂ of 85%.
Other presentations
In many of the underlying conditions that make up the hypoventilation syndromes, patients may present initially with complaints associated with disturbed sleep, including frequent nocturnal awakenings, non-restorative sleep, loud snoring, and witnessed apnoeas. In addition, in those patients with conditions associated with respiratory muscle weakness, impaired cough and repeated lower respiratory tract infections may also complicate the patient's course of illness. Finally, some patients may present in overt respiratory failure requiring emergent ventilatory support.
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