Fuyuno G, Kobayashi R, Iga R, Nomori H, Kodera K, Morinaga S
Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1995 Mar;33(3):322-6.
A 43-year-old man was admitted suffering from dyspnea on exertion and edema of the neck and face. Chest X-ray film and CT scan revealed a mediastinal tumor and a right pleural effusion. A biopsy of the tumor revealed poorly differentiated carcinoma. Severe snoring at night and excessive daytime sleepiness were noticed after admission. Nocturnal oxygen desaturation was documented with a pulse oximeter, and obstructive sleep apnea syndrome was diagnosed on the basis of results of respiratory inductive plethysmography. The severity of snoring and oxygen desaturation during sleep correlated well with the progression of facial swelling. Combination chemotherapy (carboplatin 300 mg/m2 day 1, vindesine sulfate 3 mg/m2 day 1 and 8) was started but no improvement was seen. An expandable metallic stent was inserted into the stenotic vena cava, and the facial swelling, snoring, and oxygen desaturation during sleep were promptly relieved. In this case, obstructive sleep apnea was caused by edema and vascular congestion in the upper airway, and by the decrease in pharyngeal inspiratory muscle function caused by superior vena cava syndrome.
一名43岁男性因劳力性呼吸困难及颈部和面部水肿入院。胸部X光片和CT扫描显示纵隔肿瘤及右侧胸腔积液。肿瘤活检显示为低分化癌。入院后发现患者夜间严重打鼾且白天过度嗜睡。用脉搏血氧仪记录到夜间氧饱和度下降，根据呼吸感应体积描记法结果诊断为阻塞性睡眠呼吸暂停综合征。睡眠期间打鼾的严重程度及氧饱和度下降与面部肿胀的进展密切相关。开始进行联合化疗（第1天卡铂300mg/m²，第1天和第8天硫酸长春碱3mg/m²），但未见改善。在狭窄的腔静脉内植入了可扩张金属支架，面部肿胀、打鼾及睡眠期间的氧饱和度下降立即得到缓解。在该病例中，阻塞性睡眠呼吸暂停是由上气道水肿和血管充血以及上腔静脉综合征导致的咽吸气肌功能下降引起的。
