Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 050751 Bucharest, Romania.
Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37th Dionisie Lupu Street, 020022 Bucharest, Romania.
Medicina (Kaunas). 2023 Feb 23;59(3):444. doi: 10.3390/medicina59030444.
In recent years, increased attention has been directed to sleep apnea syndrome due to its high prevalence and preventable severe health consequences. Besides enhancing the risk of cardiovascular, cerebrovascular, and metabolic disorders, it determines increased daytime somnolence, cognitive impairment, and delayed reaction time. These symptoms, determined by sleep fragmentation and chronic hypoxemia, can result in a decrease in professional performance and, moreover, could have tragic implications, especially in patients with high-risk professions. We present the case of a 58-year-old male-truck driver, known to suffer from uncontrolled OSA and chronic obstructive pulmonary disease, who presented to our ENT department for incapacitating daytime somnolence and severe nasal obstruction. These symptoms were caused by a voluminous sinonasal inverted papilloma, occupying the entire left cavity with extension in the nasopharynx. Following nose permeabilization, the patients' APAP compliance grew substantially, with a dramatic decrease in daytime sleepiness and improvement in polysomnographic parameters. Due to the overlap syndrome of OSA and COPD, an oxygen supplementation was added to PAP therapy by a pulmonologist, improving pulse-oximetry parameters and resulting in the best outcome for the patient. Through this case report, we aim to emphasize the importance of multimodal, personalized treatment of sleep apnea with a focus on nasal surgical permeabilization. At the same time, we sustain a multidisciplinary approach, especially in patients with sleep apnea and associated pathologies, to obtain therapeutic success. We propose increased attention to the early recognition and proper treatment of sleep apnea in patients with high-risk professions as it prevents catastrophes.
近年来，由于睡眠呼吸暂停综合征（Sleep Apnea Syndrome，SAS）的高发病率和可预防的严重健康后果，人们对其给予了更多的关注。除了增加心血管、脑血管和代谢紊乱的风险外，它还会导致白天嗜睡、认知障碍和反应时间延迟。这些症状是由睡眠片段化和慢性低氧血症引起的，会导致职业表现下降，而且在高风险职业的患者中，甚至可能会产生悲剧性的后果。我们报告了一位 58 岁的男性卡车司机的病例，他患有未被控制的阻塞性睡眠呼吸暂停和慢性阻塞性肺疾病（COPD），因白天嗜睡和严重的鼻塞而到我们的耳鼻喉科就诊。这些症状是由一个体积庞大的鼻-鼻窦内翻性乳头状瘤引起的，该肿瘤占据了整个左侧鼻腔，并延伸到鼻咽部。经鼻通气后，患者的持续气道正压通气（APAP）依从性显著提高，白天嗜睡症状明显减轻，多导睡眠图参数得到改善。由于重叠综合征（OSA 和 COPD）的存在，一位肺病专家在 PAP 治疗中添加了氧气补充，改善了脉搏血氧仪参数，使患者获得了最佳的结果。通过这个病例报告，我们旨在强调多模式、个性化治疗睡眠呼吸暂停的重要性，重点是鼻腔手术通气。同时，我们倡导采取多学科方法，特别是对患有睡眠呼吸暂停和相关疾病的患者，以获得治疗成功。我们建议提高对高危职业患者睡眠呼吸暂停的早期识别和适当治疗的重视，以预防灾难的发生。
