Continuous positive airway pressure for obstructive sleep apnea

During an evaluation by his internist, a 48-year-old man reports that his wife tells him that he snores loudly. Further questioning reveals that he has been falling asleep whenever sedentary. His physical examination is notable for truncal obesity (body-mass index [ the weight in kilograms divided by the square of the height in meters], 32) and hypertension ( blood pressure, 150/96 mm Hg). He is referred to a sleep specialist for nocturnal polysomnography ( sleep study), which reveals evidence of obstructive sleep apnea, with an obstructive apnea - hypopnea index ( defined as the total number of episodes of obstructive apnea and hypopnea per hour of sleep) of 50, a nadir value for arterial oxygen saturation of 65%, and an arterial oxygen saturation below 90% during 19% of sleep time. Treatment with continuous positive airway pressure (CPAP) is recommended.