A 63-Year-Old Caucasian Male Is Being Evaluated for Difficulty Sleeping

A 63-year-old Caucasian male is being evaluated for difficulty sleeping and morning headaches.  He has been sleeping upright for the last two months because he gets short of breath while lying flat.  He has also had mild dysphagia and difficulty walking for the last six months.  He denies any chest pain, palpitations, wheezing, cough, or lower extremity swelling.  His blood pressure is 127/86 mmHg and heart rate is 96/min, regular in rhythm.  His BMI is 27 kg/m².  Physical examination reveals some lower extremity muscle atrophy and tongue fasciculations.  There are minimal crackles at the right lung base.  His forced vital capacity is 57% of the predicted value while upright and 42% of the predicted value while supine.  Which of the following is the most likely cause of this patient's dyspnea?

A) Obstructive sleep apnea
B) Recurrent aspiration
C) Dilated cardiomyopathy
D) Diaphragmatic paralysis
E) Interstitial lung disease

Correct Answer:

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