P10‐17: Idiopathic central alveolar hypoventilation without respiratory failure that required differentiation from obstructive sleep apnea

BackgroundObstructive sleep apnea (OSA) is increasingly prevalent in the range of 2% to 24% in the US population. OSA is a well-described predictor of pulmonary complications after elective operation. Yet, data are lacking on its effect after operations for trauma. We hypothesized that OSA is an independent predictor of pulmonary complications in patients undergoing operations for traumatic pelvic/lower limb injuries (PLLI).MethodsNationwide Inpatient Sample (2009–2013) was queried for International Classification of Diseases, Ninth Revision, Clinical Modification codes for PLLI requiring operation. Elective admissions and those with concurrent traumatic brain injury with moderate to prolonged loss of consciousness were excluded. Outcome measures were pulmonary complications including ventilatory support, ventilator-associated pneumonia, pulmonary embolism (PE), acute respiratory distress syndrome (ARDS), and respiratory failure. Multivariable logistic regression analysis was used, adjusting for OSA, age, sex, race/ethnicity, and specific comorbidities (obesity, chronic lung disease, and pulmonary circulatory disease). P<0.01 was considered statistically significant.ResultsAmong the 337 333 patients undergoing PLLI operation 3.0% had diagnosed OSA. Patients with OSA had more comorbidities and were more frequently discharged to facilities. Median length of stay was longer in the OSA group (5 vs 4 days, p<0.001). Pulmonary complications were more frequent in those with OSA. Multivariable logistic regression showed that OSA was an independent predictor of ventilatory support (adjusted odds ratio (aOR), 1.37; 95% CI,1.24 to 1.51), PE (aOR 1.40; 95% CI, 1.15 to 1.70), ARDS (aOR 1.36; 95% CI,1.23 to 1.52), and respiratory failure (aOR 1.90; 95% CI, 1.74 to 2.06).ConclusionOSA is an independent and underappreciated predictor of pulmonary complications in those undergoing emergency surgery for PLLI. More aggressive screening and identification of OSA in trauma patients undergoing operation are necessary to provide closer perioperative monitoring and interventions to reduce pulmonary complications and improve outcomes.Level of evidencePrognostic Level IV.

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Primary alveolar hypoventilation syndrome combined with severe obstructive sleep apnea hypopnea syndrome in a post-middle-aged patient

Psychiatry and Clinical Neurosciences ◽

10.1111/j.1440-1819.2004.01304.x ◽

2004 ◽

Vol 58 (5) ◽

pp. 582-583

Author(s):

GEN-I HAZAMA ◽

YUICHI INOUE ◽

SHIGERU HIGAMI ◽

MAKOTO IMAOKA ◽

RYUZO KAWAHARA

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Severe Obstructive Sleep Apnea ◽

Aged Patient ◽

Middle Aged ◽

Obstructive Sleep ◽

Alveolar Hypoventilation ◽

Hypoventilation Syndrome ◽

Hypopnea Syndrome

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Obstructive sleep apnea and acute respiratory failure: An analysis of mortality risk in patients with pneumonia requiring invasive mechanical ventilation

Journal of Critical Care ◽

10.1016/j.jcrc.2015.03.016 ◽

2015 ◽

Vol 30 (4) ◽

pp. 778-783 ◽

Cited By ~ 10

Author(s):

Raymonde E. Jean ◽

Charlisa D. Gibson ◽

Raymond A. Jean ◽

Pius Ochieng

Keyword(s):

Mechanical Ventilation ◽

Obstructive Sleep Apnea ◽

Respiratory Failure ◽

Sleep Apnea ◽

Acute Respiratory Failure ◽

Mortality Risk ◽

Invasive Mechanical Ventilation ◽

Obstructive Sleep

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Coexistence of Obstructive Sleep Apnea and Superior Vena Cava Syndromes Due to Substernal Goitre in a Patient With Respiratory Failure: A Case Report

Iranian Red Crescent Medical Journal ◽

10.5812/ircmj.17(5)2015.18342 ◽

2015 ◽

Vol 17 (5) ◽

Cited By ~ 3

Author(s):

Mehtap Tunc ◽

Hilal Sazak ◽

Bulent Karlilar ◽

Fatma Ulus ◽

Irfan Tastepe

Keyword(s):

Obstructive Sleep Apnea ◽

Case Report ◽

Respiratory Failure ◽

Sleep Apnea ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Obstructive Sleep

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Clinical features and outcome in obese patients with undiagnosed obstructive sleep apnea admitted with respiratory failure in a tertiary care center

10.1183/13993003.congress-2016.pa2328 ◽

2016 ◽

Author(s):

Nousheen Iqbal ◽

Muhammad Irfan ◽

Ali Zubairi ◽

Safia Awan ◽

Javaid Khan

Keyword(s):

Obstructive Sleep Apnea ◽

Respiratory Failure ◽

Sleep Apnea ◽

Clinical Features ◽

Care Center ◽

Tertiary Care ◽

Obese Patients ◽

Tertiary Care Center ◽

Obstructive Sleep

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1236 A Case of Systemic Amyloidosis and Sleep-Related Hypoventilation

SLEEP ◽

10.1093/sleep/zsaa056.1230 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A471-A472

Author(s):

Lauren M Castner ◽

Mark D Garwood

Keyword(s):

Obstructive Sleep Apnea ◽

Respiratory Failure ◽

Sleep Apnea ◽

Systemic Disease ◽

Central Sleep Apnea ◽

Systemic Amyloidosis ◽

Rapid Progression ◽

Bilevel Positive Airway Pressure ◽

Obstructive Sleep ◽

History Of

Abstract Introduction Amyloidoses are a group of systemic diseases characterized by misfolded protein fragment deposition within the organs, including the heart, kidney, liver, gastrointestinal tract, nervous system, pulmonary system, and soft tissues1. Obstructive and central sleep apnea are known to occur frequently in those with cardiac amyloidosis. This case discusses a patient with systemic amyloidosis and chronic hypercarbic, hypoxic respiratory failure. Report of Case A 66 year old female with a history of systemic amyloidosis, non-ischemic cardiomyopathy, hypertension, and obstructive sleep apnea was admitted for acute on chronic heart failure. Despite intravenous diuresis, she remained hypoxemic, requiring 1 liter per minute of oxygen. She was found to have bilaterally reduced diaphragmatic excursion and a restrictive ventilatory defect on spirometry. She had a preceding history of chronic carbon dioxide retention with elevated CO2 levels for greater than a year (52-74 mmHg). Sleep medicine was consulted to assist in evaluation of the patient’s obstructive sleep apnea and hypoxic, hypercarbic respiratory failure. Baseline polysomnogram revealed sleep related hypoventilation with transcutaneous CO2 (TCO2) ranging between 77-86 mmHg without clear obstructive sleep apnea. A bilevel positive airway pressure (BPAP) titration was then performed (TCO2 54-69 mmHg) and while the patient’s obstructive sleep apnea was well treated, sleep-related hypoventilation and central apneas persisted. Average volume assured pressure support (AVAPS) was initiated for management of sleep related hypoventilation. In follow up, the patient is feeling well, off oxygen, with daytime TCO2 38 mmHg. Conclusion This case demonstrates a rare complication of systemic amyloidosis in the setting of respiratory failure attributed to amyloid infiltration of the diaphragm. In the few previously reported cases of neuromuscular respiratory failure in systemic amyloidosis there is rapid progression and high mortality3, which highlights the importance of assessing for sleep disordered breathing and additional causes of respiratory failure in a patient with a complex systemic disease.

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