رجل عمره ٥٢ سنة وزنه ١١٨ كغ، عنده انقطاع النفس الانسدادي أثناء النوم (OSA) وارتفاع ضغط. يستخدم جهاز CPAP منذ شهر، ويقول إنه يتركه بعد ساعة لأن القناع يضايقه والهواء يتسرب على عينيه، وما زال ينام في العمل. أي تدخل أنسب؟

A 52-year-old man weighing 118 kg with obstructive sleep apnoea and hypertension has used CPAP for a month. He says he removes it after an hour because the mask is uncomfortable and air leaks into his eyes, and he still dozes at work. Which intervention is most appropriate?

1. Stop the device and try sleeping on his back
2. Advise a sleeping pill instead of the device
3. Assess mask fit and comfort and refer for adjustment
4. Tell him the device does not matter if he sleeps well

Answer: C) Assess mask fit and comfort and refer for adjustment. Mask discomfort is the commonest reason for abandoning CPAP; adjusting fit, pressure and humidification improves adherence. Untreated OSA raises blood pressure, cardiac risk and accidents, and sedatives can worsen apnoea.