Hi doctor, I am a 45 year old male. A month back, I was diagnosed with sleep apnea. I have enclosed my report here. I feel breathless at night while lying down and I was advised it as because of sleep apnea. I have been trying to use a CPAP. For past two months I am experiencing breathlessness on even slight exertion like walking for a few minutes, bending down, etc. My doctor said it may be due to coronary ischemia. I had a positive TMT and may have to undergo an angiography. My chest physician said it as bronchoconstriction. He prescribed Foracort inhaler, Duolin inhaler, Deriphyllin retard and Montek. The unresolved problem I am facing now is a sudden involuntary exhalation of breath. This happens more often at night, from time to time breath exhales in a sudden explosive spurt that almost throws up my body a bit something like hiccups from the stomach. This happens many times at night and disturbs sleep. It also happens the moment I put on my CPAP full face mask. Earlier it was more while using the CPAP and nowadays it happens even without the CPAP. Also my wife says that even with CPAP sometimes I am absolutely still, not breathing while sleeping. My father is a heart patient and he also has COPD. My mother suffered with asthma and now got cured of it. I do not smoke or drink alcohol and I am a vegetarian. In addition to the above tests, my chest X-ray was normal. Five months back I had an echo and brain MRI, which are all also normal. Brain MRI was taken because I had some balancing issues which were then diagnosed as uncompensated vestibular lesion. I also have severe cervical spondylosis. What could be the cause of this sudden aggressive exhalation? Could my breathlessness issue be entirely due to lungs? If so should I undergo angiography? Thanks in advance.
Hi. I have read through your query and reports (attachment removed to protect patient identity) in detail. Please find my observations below. There is a probability of having a parasomnia which is defined as sleep disorders that involve abnormal movements and features like aggressive exhalation, partial awakening, arousal with confusion, sleep terror and related symptoms. This problem is in addition to the obstructive sleep apnea which is there in you. Studies show that 9.5 percent of people with obstructive sleep apnea might have parasomnia. About 20 percent of patients experience improvement and decrease in episodes of parasomnia after CPAP (continuous positive airway pressure) and it is persisting even with CPAP in you. At 45 years, getting a CT angiography is suggested. It is a low risk procedure comparable with the cath lab angiography. Doing lipid profile and cardiac enzyme test is also important. For further information consult a pulmonologist online -->