What are the differential diagnoses for a 50-year-old woman with progressively worsening bilateral painful burning in her hands and arms that occurs only while she is asleep?
—PAULINE ABOLNAR, ANP-FNP, Northport, N.Y.
Both the pulmonary and the neurologic literature document cases of peripheral neuropathic symptoms in the presence of significant obstructive sleep apnea. The burning is attributable to the ischemic process that occurs in the distal capillary system as a result of oxygen desaturation during apneic periods.
—Sherril Sego, MSN, FNP (132-1)