We don’t talk enough about the relationship between sleep apnea and lower extremity edema. A lot of patients fall asleep while I am talking to them, and I don’t think the problem is my personality. Edema is THE most common diagnosis we see in the outpatient wound center (nearly every patient with any type of lower extremity wound/ulcer has edema, have you noticed that?). There are a lot of reasons for leg edema. Venous insufficiency is only one of them, and maybe not the most important one.

The patients are often chair sleepers, sometimes due to rest pain from arterial disease but often due to sleep apnea. And while I do find a lot of right heart failure that gets missed even by cardiology, many time their right heart still looks OK on echo. Still, the triad of chair sleeping, inadequately treated (or untreated) sleep apnea and leg edema is pervasive, and often overlooked.

The most useful question that I ask these patients is, “Do you sleep in the bed or a chair?” And if they say the chair, the next question is, “Why?”

Seriously, the fix for a patient like this is not venous ablation, and typical compression bandaging is not going to manage edema that extends to the buttocks. It’s hard to know where to start sometimes. All I know is that the problems I treat are all SYMPTOMS of disease.