Obstructive Sleep Apnea Associated with Leg Edema

to the editor: In an otherwise comprehensive review of the causes and treatment of edema in American Family Physician, O’Brien and colleagues make no mention of idiopathic edema or sleep apnea. Several years ago, my colleagues and I identified idiopathic edema as the most common cause of bilateral leg edema in the primary care setting. More recently, we have shown that idiopathic edema is associated with obstructive sleep apnea in women. In addition, treating the obstructive sleep apnea reduces or eliminates the amount of swelling in patients who have obstructive sleep apnea and leg edema. This information may or may not have an impact upon the clinical care of patients with edema. The majority of my patients with obstructive sleep apnea and leg edema are not interested in treating the obstructive sleep apnea, primarily because they do not complain of excessive daytime sleepiness. Consequently, I often prescribe a diuretic to treat the leg edema, which is what many physicians do when their patients complain of leg edema with no apparent cause.

Robert P. Blankfield, M.D., M.S.

I have had swollen ankles in the past somewhat but now that I am on cpap for one month they are SO much worse.