Loube Daniel I., McCambridge Matthew M., Andrada Teotimo
Pulmonary and Critical Care Medicine Service, Walter Reed Army Medical Center, Washington, DC.
Sleep Breath. 1999;3(1):9-12. doi: 10.1007/s11325-999-0009-4.
We report on a patient with the onset of recurrent nocturnal awakenings associated with postawakening stridor with onset a few weeks after receiving radiation therapy to the neck. The onset of nocturnal stridor was also accompanied by complaints of snoring and excessive daytime sleepiness. Stridor did not occur during daytime wakefulness. Nocturnal polysomnography (NPSG) recorded with a calibrated pneumotachometer demonstrated snoring and severe obstructive sleep apnea (OSA) with a apnea/hypopnea index of 51 events/hr. One apneic episode persisted for 17 sec after the onset of wakefulness as evidenced by standard NPSG scoring criteria for arousals. With this event, video monitoring revealed the patient abruptly sitting upright and clutching his throat and auditory recording demonstrated stridorous sounds. During wakefulness endoscopy revealed moderate edema and erythema of the supraglottic region, epiglottis, palatine tonsils, and false and true vocal cords. Vocal cord function appeared normal. This case report represents the observation of two rare findings in a single patient, persistence of apnea in wakefulness, and OSA onset following neck irradiation. We review the literature on the persistence of apnea in wakefulness and discuss possible mechanisms for its occurrence in this patient.
我们报告了一名患者，在接受颈部放射治疗几周后出现反复夜间觉醒，并伴有觉醒后喘鸣。夜间喘鸣发作还伴有打鼾和日间过度嗜睡的症状。白天清醒时未出现喘鸣。使用校准的呼吸流速仪进行的夜间多导睡眠图（NPSG）记录显示有打鼾和严重的阻塞性睡眠呼吸暂停（OSA），呼吸暂停/低通气指数为51次/小时。根据标准的NPSG觉醒评分标准，有一次呼吸暂停发作在觉醒开始后持续了17秒。在此事件中，视频监测显示患者突然坐直并捂住喉咙，音频记录显示有喘鸣音。清醒时的内镜检查显示声门上区、会厌、腭扁桃体以及真假声带中度水肿和红斑。声带功能似乎正常。本病例报告展示了在一名患者身上观察到的两个罕见发现，即清醒时呼吸暂停的持续存在以及颈部放疗后OSA的发作。我们回顾了关于清醒时呼吸暂停持续存在的文献，并讨论了该患者出现这种情况的可能机制。
