Herlihy J P, Whitlock W L, Dietrich R A, Shaw T
Pulmonary Disease Service, Letterman Army Medical Center, Presidio of San Francisco, CA 94129-6700.
Arch Otolaryngol Head Neck Surg. 1989 Dec;115(12):1467-9. doi: 10.1001/archotol.1989.01860360069020.
After irradiation of the neck for a squamous cell carcinoma of the tonsillar pillar and vocal cord, a 71-year-old man presented with a rapidly progressive sleep apnea syndrome. Previous reports describe the condition of patients with obstructive sleep apnea that developed after neck irradiation and secondary to supraglottic edema. Our patient had an obstructive component to his apnea similar to that described in previous cases, but, in addition, he had hypothyroidism. Myxedema is a well-described cause of both obstructive and central apnea. We believe both contributed to his condition. He was successfully treated by placement of a tracheostomy and by thyroid supplementation. In patients who present with sleep apnea after neck irradiation, especially with acute or severe symptoms, the differential diagnosis should include both a central cause from hypothyroidism as well as a peripheral obstructive cause from laryngeal edema.
一名71岁男性因扁桃体柱和声带鳞状细胞癌接受颈部放疗后，出现快速进展的睡眠呼吸暂停综合征。既往报告描述了颈部放疗后发生且继发于声门上水肿的阻塞性睡眠呼吸暂停患者的情况。我们的患者的呼吸暂停有阻塞性成分，与既往病例中描述的相似，但除此之外，他还有甲状腺功能减退。黏液性水肿是阻塞性和中枢性呼吸暂停的一个广为人知的病因。我们认为这两者都导致了他的病情。通过气管造口术和补充甲状腺素，他得到了成功治疗。对于颈部放疗后出现睡眠呼吸暂停的患者，尤其是有急性或严重症状的患者，鉴别诊断应包括甲状腺功能减退引起的中枢性病因以及喉水肿引起的外周阻塞性病因。
