MRCP2-4503

MRCP2-4503

A 57-year-old man presents to the clinic for evaluation. He reports excessive daytime sleepiness, causing him to fall asleep multiple times during the day and lose his job as a taxi driver. He has a history of hypertension treated with Ramipril and is otherwise healthy. His wife reports that he snores throughout the night and frequently stops breathing. On examination, his BP is 158/88 mmHg, his pulse is 78 bpm, and his BMI is 38 kg/m2 with a collar size of 18.5.

Lab results show Hb of 135 g/l, WCC of 6.9 x109/l, PLT of 188 x109/l, Na+ of 137 mmol/l, K+ of 4.3 mmol/l, creatinine of 108 micromol/l, and fasting glucose of 8.1 mmol/l. A sleep study reveals over 10 hypoxic episodes associated with apnea during the overnight period.

What is the most effective long-term intervention for this patient?