Clinical Intake — Obstructive sleep apnea

A 54-year-old male presents with a 34-month history of moderate-to-severe obstructive sleep apnea confirmed on attended polysomnography (AHI 38.2 events/hr). He completed a supervised 90-day PAP trial across three mask interfaces but remained intolerant due to persistent claustrophobia and mask leak, with average nightly use under two hours—well below therapeutic thresholds. BMI is 31.2 kg/m². Drug-induced sleep endoscopy revealed a concerning collapse pattern at the velum with features ambiguous between concentric and anteroposterior-dominant configurations, and no prior pharyngeal surgery has been performed. Given persistent symptomatic burden and documented PAP failure, the treating otolaryngologist recommends specialist assessment for surgical management options.