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.
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I also find a skin phenomenon known among most wound specialist as “recliner butt” Where the repetitive sleeping in the chair causes chronic tissue injury that appears deep red to purple in color. There are pictures of this in articles in the WOCN journal magazine and Advances in Wound and Skin journal.
Myra, I absolutely agree.
I would also wager that this person has incontinence issues.
I am not a chair sleeper but do suffer from a chronic ulcer and have long term OSA. I don’t have venous insufficiency as ruled out by arterial and vein scans, am not diabetic but have had a leg ulcer for over a year now. It began to show signs of healing thanks to an infectious disease specialist who found colonization of staph (which was found before but ill-treated with oral antibiotics) and taken care of with antibiotics via a midline. Compression was finally tolerated (severe pain prevented it, even on Oxycodone) After three weeks of being painkiller free, new areas next to the old wound began to open up and the doctors are even more perplexed.