Leznoff A, Haight J S, Hoffstein V
Am Rev Respir Dis. 1986 May;133(5):935-6.
This report describes a case of reversible obstructive sleep apnea caused by occupational exposure to an inhaled allergen, guar gum powder. The patient, a pet food plant employee, also experienced severe cough, rhinitis, and conjunctivitis. Skin tests confirmed the specific guar allergy. Pharyngeal cross-sectional area was smaller than normal. Pulmonary function studies, histamine challenge tests, nasal air-flow resistance measurements, and nocturnal polysomnography were performed on 3 separate occasions: while the patient was working at his usual occupation, at the end of a 3-wk holiday, and after a guar dust challenge in an inhalation chamber. Pulmonary function and histamine challenge tests were consistently normal. At the time of the initial tests, nasal resistance was elevated, and nocturnal polysomnography revealed obstructive sleep apnea. After absence from work, obstructive sleep apnea resolved, and the nasal resistance returned to normal. After challenge with guar gum dust, the patient developed increased resistance to nasal air flow, and obstructive sleep apnea reappeared. This case demonstrates that allergy can cause reversible obstructive sleep apnea and that occupational exposure should be considered in the assessment of patients with this disease.
本报告描述了一例因职业接触吸入性变应原瓜尔胶粉导致的可逆性阻塞性睡眠呼吸暂停病例。该患者为宠物食品厂员工，还出现了严重咳嗽、鼻炎和结膜炎。皮肤试验证实了对瓜尔胶的特异性过敏。咽部横截面积小于正常。在3个不同时间点进行了肺功能研究、组胺激发试验、鼻气流阻力测量和夜间多导睡眠图检查：患者从事日常工作时、3周假期结束时以及在吸入室进行瓜尔胶粉尘激发试验后。肺功能和组胺激发试验始终正常。初次检查时，鼻阻力升高，夜间多导睡眠图显示阻塞性睡眠呼吸暂停。缺勤后，阻塞性睡眠呼吸暂停消失，鼻阻力恢复正常。用瓜尔胶粉尘激发试验后，患者鼻气流阻力增加，阻塞性睡眠呼吸暂停再次出现。该病例表明，过敏可导致可逆性阻塞性睡眠呼吸暂停，在评估此类疾病患者时应考虑职业暴露因素。
