Sahoo Ayaskant
Anesthesiology, Manipal Tata Medical College, Jamshedpur, IND.
Cureus. 2023 May 18;15(5):e39184. doi: 10.7759/cureus.39184. eCollection 2023 May.
Obstructive sleep apnea (OSA) is now increasingly recognized as a disease entity that can play a major role in affecting multiple organ systems. Even though the symptoms of OSA were first described in the 19th century as Pickwickian syndrome, there are a lot of things that came to be known only recently including its pathophysiology and diagnosis. In this case report, we present some findings that mostly have not been reported in OSA patients before. It has been reported that OSA patients have a typical arterial blood gas (ABG) picture of raised bicarbonate (HCO-) levels, which also aid in adding to the diagnosis, but we found some more findings that are only specific to the apneic phase of the disease. A 65-year-old female patient was put on a ventilator due to dengue-associated acute respiratory distress syndrome (ARDS). She was also diagnosed with obstructive sleep apnea after facing difficulty in weaning from a ventilator. Post extubation, she was put on noninvasive ventilation (NIV), but the patient's arterial blood gas (ABG) drawn during the apneic phase was showing signs of severe metabolic acidosis even on NIV. This was reversible and gets corrected once the patient is awakened or put on NIV. Clinical decisions from ABG in a patient with OSA may result in errors especially when the ABG is drawn during the apneic phase of the disease. Clinicians have to be careful of this phenomenon, and more research needs to be undertaken to fully understand the pathophysiology of this phenomenon.
阻塞性睡眠呼吸暂停（OSA）现在越来越被认为是一种在影响多个器官系统方面起主要作用的疾病实体。尽管OSA的症状早在19世纪就被描述为匹克威克综合征，但直到最近才了解到很多情况，包括其病理生理学和诊断。在本病例报告中，我们展示了一些以前在OSA患者中大多未被报道的发现。据报道，OSA患者有典型的动脉血气（ABG）表现，即碳酸氢盐（HCO -）水平升高，这也有助于辅助诊断，但我们发现了一些仅在该疾病呼吸暂停期特有的更多发现。一名65岁女性患者因登革热相关的急性呼吸窘迫综合征（ARDS）而使用呼吸机。在撤机困难后，她也被诊断为阻塞性睡眠呼吸暂停。拔管后，她接受了无创通气（NIV），但即使在NIV期间，患者在呼吸暂停期抽取的动脉血气（ABG）仍显示出严重代谢性酸中毒的迹象。这是可逆的，一旦患者醒来或接受NIV就会得到纠正。对于OSA患者，ABG的临床决策可能会导致错误，尤其是在疾病呼吸暂停期抽取ABG时。临床医生必须注意这种现象，并且需要进行更多研究以充分了解这种现象的病理生理学。
