Jim Mitzas Case Study

Thank you for referring Jim Mitzas, a 45-year-old team leader who works for Energy Australia in an office environment. Jim is a non-smoker and seldom consumes alcohol. There is a longstanding history of Crohn’s disease that has been quite stable with mesalazine. Other current medications are Pariet, Panadeine Forte and Brufen.

Regarding his sleep, Jim usually retires to bed at around 11.30pm with what he perceives to be prolonged sleep onset latency of around one hour. He often has trouble finding a comfortable position and reports an overactive mind. There is a history of snoring, witnessed apnoea, nocturia, sleep fragmentation and when he wakes at 5.30am, he consistently feels unrefreshed. Jim is also been noted to sit up at the

Chest auscultation was clear and two heart sounds were audible with nil else.

Prior to this appointment, Jim has undergone a home-based diagnostic sleep study through the Austin. This has revealed short sleep onset latency of 3.5 minutes with reduced sleep efficiency. There is severe obstructive sleep apnoea with an Apnoea-Hypopnoea Index of 84 events/hr. There was significant oxygen desaturation during the night with more than 50% time of total sleep time spent with a saturation of less than 88%. There were no notable periodic limb movements.

I have discussed the findings with Jim and given the severity of his sleep apnoea, CPAP is certainly indicated. He will commence treatment at home, initially using an auto-set machine followed by a fixed pressure device. I will review him again in a month to assess his progress. He will notify VicRoads of the sleep apnoea diagnosis. I do agree that in due course undergoing a tonsillectomy and septoplasty will likely improve his sleep apnoea and allow use of lower CPAP pressures. Hopefully, Jim will also be able to make an attempt at weight-loss with improved energy