[Answered]: Admitting History A 42-year-old obese man sought…

Admitting History A 42-year-old obese man sought medical advice because of excessive daytime sleepiness and impotence of increasing severity over a period of 3 months. His history was not contributory except that the patient admitted to moderate but daily alcohol use. Discussion with the patient’s wife revealed that the patient was snoring so consistently and so loudly that she was forced to sleep in a separate bedroom. Physical Examination On physical examination, he was found to be in no acute distress and cooperative. He was 5’10” tall and weighed 147 kg (323 lbs). He had a blood pressure of 152/90 and a heart rate of 92/min. The remainder of the physical examination was within normal limits. The laboratory examination showed a hematocrit of 50%. His hemogram, urinalysis, and hepatic and renal function tests were within normal limits. The patient was referred to the sleep disorders laboratory of a nearby university hospital, where monitoring during sleep revealed frequent (30/hr) obstructive apneic episodes (as long as 60 seconds in duration), episodic oxygen desaturation to 70%, and cyclical bradycardia. A diagnosis of obstructive sleep apnea was made. An initial, conservative program of weight reduction was instituted, with advice to abstain from all alcoholic beverages and to sleep in the lateral decubitus position with the head of the bed elevated. On a return visit 2 months later, it was found that the patient had gained 20 kg and had not abstained from alcohol. His daytime sleepiness was not improved. He snored just as much as before. He stated he was sleepy and his wife complained about his snoring. There was 2+ leg edema. His lungs were clear to auscultation, and the electrocardiogram (ECG) revealed a sinus tachycardia of 110/min. A chest x-ray showed right-sided cardiac enlargement without pulmonary infiltrates. In the sleep disorders laboratory, an awake room air ABG analysis showed pH 7.35, Paco2 55, HCO3- 30, and Pao2 61. He was admitted to the hospital. At this time, the respiratory care practitioner entered a SOAP note. Based on the above clinical data, how would you SOAP this patient upon admission? (SOAP 1) This patient was advised to sleep in the lateral decubitus position. Describe this position in your own words. There are basically three types (causes) of sleep apnea. Explain below which type of sleep apnea you think this patient may have.