Abouganem D, Taylor A L, Donna E, Baum G L
Arch Intern Med. 1987 Aug;147(8):1497-9.
A 52-year-old man with myxedema was evaluated for anterior chest pain that was considered to be compatible with myocardial ischemia. The night after admission he developed extreme bradycardia, hypotension, and apneic episodes lasting up to 25 s. Continuous positive airway pressure and administration of medroxyprogesterone acetate prevented further episodes and relieved much of the somnolence and lethargy that had contributed to the evidence for myxedema. Alveolar hypoventilation caused by decreased sensitivity to carbon dioxide, inadequate central neural drive, peripheral muscle force, and obesity all may have contributed to the apnea. Chest pain has not recurred, and results of electrocardiography have remained normal following full thyroid hormone replacement. The early recognition of myxedema causing sleep apnea will allow specific treatment to avoid the cardiovascular risks related to prolonged apnea and will help avoid confusion with other etiologies of cardiovascular abnormalities.
一名52岁的黏液性水肿患者因被认为与心肌缺血相符的前胸疼痛而接受评估。入院后的当晚，他出现了极度心动过缓、低血压以及持续长达25秒的呼吸暂停发作。持续气道正压通气和醋酸甲羟孕酮的使用防止了进一步发作，并缓解了许多导致黏液性水肿证据的嗜睡和昏睡症状。对二氧化碳敏感性降低、中枢神经驱动不足、外周肌肉力量以及肥胖导致的肺泡低通气都可能导致了呼吸暂停。胸痛未再复发，在完全补充甲状腺激素后心电图结果一直正常。早期识别导致睡眠呼吸暂停的黏液性水肿将允许进行特定治疗，以避免与长时间呼吸暂停相关的心血管风险，并有助于避免与心血管异常的其他病因相混淆。
