Electrocardiographic Features Associated With Obstructive Sleep Apnea

Scenario: This electrocardiogram (ECG) was obtained by paramedics from a 52-year-old man with chest heaviness, chest “fluttering,” and shortness of breath (SOB) for several hours after moving heavy items into his car. The patient stated that for the past week, he has been using pillows at night to sleep because of SOB when he lays flat. His medical history includes hypertension, type 1 diabetes, hyperlipidemia, and obstructive sleep apnea (OSA). He was obese, with a body mass index (weight in kilograms divided by height in meters squared) of 38. Current medications included amlodipine, long-acting insulin, and simvastatin. To treat his sleep apnea, he was prescribed continuous positive airway pressure for night use, but he said that he does not use it consistently and recalls not using it for several weeks. Pertinent vital signs and assessment included blood pressure, 158/94 mm Hg; heart rate, 103/min; temperature, 97.8 °F (36.6 °C);...