Case 45 – History


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Case 45

Death during sleep


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Brief Past Medical History

The patient was an elderly Caucasian man with a history of lymphoma versus pre-lymphoma (monitored with blood testing).

No treatment was offered or indicated, per the family.

In addition, the patient had prostatic hypertrophy treated with medication; hypertension treated with medication; and mildly elevated cholesterol which was diet-controlled.

The diet was reported as “healthy, with many vegetables, fish and occasional meats.”

The patient also had sleep apnea and used a CPAP device (at his discretion) and a sleep apnea monitor.


Recent Events

The CPAP device had been broken and unusable for approximately the past two weeks.

The patient had received a second shingles vaccine approximately one week prior to death.

The patient was in his usual state of health, shoveling snow approximately two days prior.

He was found dead in his bed by the family in the afternoon.


Additional information/data provided by the family

No pill bottles where identified nearby.

The patient’s sleep-wake audio recording was provided for review by the family.

The audio indicated that the patient was asleep during the time of his death.

There was a period of approximately 10 seconds of marked snoring followed by a brief pause and then two agonal, deep, snoring breaths prior to cessation of breathing and death.

The patient did not awaken during this time period.

Per monitoring, the death occurred overnight several hours after the patient went to sleep.

This history is obtained from the family.


Next: Part 1

Discussion Questions

1. Summarize the history.
2. What is your differential diagnosis for the cause of death?
3. What recent events may have precipitated or contributed to the death? Why?
4. Based on the history, predict what findings you might expect inside the body.