Renal Case: 59-year-old Man who Snores

00:01 Let's talk about another clinical case.

00:03 You have a 59-year-old gentleman with a history of obesity, impaired fasting glucose, and hypertension on monotherapy with an ACE-inhibitor lisinopril.

00:12 He's seen in the office for complaints of increasing daytime hypersomnolence so he's tired during the day.

00:17 He notices that he's now falling asleep at stop lights while he's driving.

00:21 He's getting concerned about that and he's got worsening morning headaches and worsening control of his blood pressures.

00:26 His partner who accompanies him at the visit today notes that he has terrible snoring and ofter times, can't even sleep in the same room because of the patient's loud snoring.

00:36 And then notice these kind of resuscitative snorts throughout the night.

00:39 On physical exam, the patient is obese, he has a wide neck girth, and blood pressure is elevated at 160/82 mmHg. Labs are unremarkable.

00:48 So, the question is, what is the most likely cause that's contributed to the patient's worsening blood pressure control and responsible for the patient's complaints? Let's go back to our case and see if we've got some diagnostic clues.

01:01 So, remember, the patient is obese, he's complaining of daytime hypersomnolence, so sleepiness during the day.

01:09 He's got these morning headaches, worsening control of blood pressure.

01:12 All of those are really suggestive of sleep-related breathing disorder.

01:17 The snoring, and what we call resuscitative snorts, so people waking up and waking themselves up because of their breathing along with an obese body habitus and wide neck girth can absolutely contribute to sleep-related or sleep-related breathing disorders.

01:34 So, what is the most likely cause that's contributed to the patient's worsening blood pressure control and responsible for his symptoms? Obstructive sleep apnea.