A 54-year-old man with acute onset orthopnea and sleep-related hypoxia

摘要

A 54-year-old white man with a BMI of 29 presented with a 6-month history of supine positional snoring and progressive orthopnea without antecedent illness, trauma, or venous thromboembolism. He required daytime oxygen therapy at 3 L/minute and was unable to tolerate laying supine due to severe orthopnea. He slept in a recliner. Epworth score was 5. Chest examination demonstrated limited diaphragmatic excursions, bilaterally absent breath sounds, and dullness to percussion over the lower chest. Upon recumbency, he became tachypneic and had abdominal paradox with accessory muscle activation.