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Case of 25 Years Old Female with Snoring and Sleep Apnea

Sushmeet Kaur, 25 yrs old female presented in the E.N.T. Department, Govt. Medical College, Amritsar with chief complaint of difficulty in breathing at times.

• H/o nasal obstruction with nasal as well as post nasal discharge
• H/o of occasional headache and irritability
• Sleepiness always
• Inability to concentrate at work
• Dryness of mouth and Feeling of giddiness
• According to her parents, patient had problem of snoring and mouth breathing since childhood along with nasal obstruction at times.
• At present she is breast feeding her infant son.
• No history of any intake of hormonal therapy
• H/o slight weight gain after the delivery due to sedentary lifestyle.
• No past history of any menstrual abnormality.
• No H/o any intake of medicines except for nasal drops and deriphyline at times.

PAST HISTORY:

• H/o similar episode in the past which increased many folds after delivery.
• No known history of hypertension or diabetes.

Patient was brought to the OPD by her husband. According to him patient was snoring, which was disturbing and he also mentioned that due to this he was getting sleepless at night. She had cessation of breathing many a times during night. Her snoring was quite annoying even to the other family members’ next room. She also tends to forget feeding her four months child many a time.

• History of day time sleepiness (ਪਾਠ ਕਰਦੇ-ਕਰਦੇ ਸੌਂ ਜਾਂਦੀ ਹੈ |)
• Mood swings and irritability.
• Extreme restlessness in the legs while trying to sleep.
• No history of trauma to the nose.
• No history of indigestion & chest pain.

CLINICAL EXAMINATION:

Patient was moderately built, clinically appeared to be anaemic, anxious looking, mouth breather, dry lips, slight overcrowding of teeth.

• On examination tonsils markedly enlarged.
• Mallam Patti score was calculated to be two.
• Nasal passages congested with mild running of nose.
• Patient complained of nasal obstruction.
• Evidence of multiple enlarged lymph nodes along the jugular chain
• FNAC was done (2-3 groups of cells having round to oval nuclei, cytoplasm moderate and the report was Round Cell Tumor), biopsy was advised, which sent shock waves in the family because there was history of death of her younger sister at age of 18 due to lymphoma.
• CT scan and MRI was done and the opinion given was astonishing and surprising and the reporting doctors said “hypertrophy of the adenoid tissue and the palatine tonsils bilaterally causing marked narrowing of the airways.”
• X-ray chest was normal.
• All the investigations except for haemoglobin and peripheral blood gas analysis were normal.
• Nasal endoscopy was done and it showed bilateral lobulated lesion. The mass was coming from roof of nasopharynx and occupying both choanae. There was limited space between mass and palate.
• Biopsy was taken and there wasn’t much bleeding.
• H/P report: Features suggestive of a lymphoproliferative lesion, possibly reactive type, could be consistent with the clinical and MRI impression of adenoids.

AIM OF TREATMENT:

• Our aim of treatment should be that the patient of sleep apnea and snoring should wake up completely relaxed having more energy during the day and fall asleep in his partner’s arms at night.
• Sleep restores us…………………….
• After anaethesia checkup patient was subjected to Tonsillo-Adenoidectomy. The mass was removed and sent for biopsy.  The report came consistent with the biopsy taken previously.

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