A simple intervention that markedly reduces the effectiveness of positive airway pressure

An 81-year old female with multiple medical comorbidities was referred for evaluation of sleep-disordered breathing (SDB). History was significant for loud snoring, which was worse lying on the back, snort arousals and witnessed apnea. She had 3-4 awakenings due to nocturia, felt unrefreshed in the morning, endorsed significant daytime sleepiness, and took an hour-long daytime nap three times a week. Pertinent findings on physical examination were a body mass index of 18 kg/m2 (weight 48 kg), narrow nasal passages, Friedman palatal position class IV, and a slightly retrognathic lower jaw.

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