Obstructive sleep apnoea in a patient with chronic lymphocytic leukaemia

A 69-year-old Caucasian woman presented with chronic lymphocytic leukaemia (CLL; stage 1-Rai System), significant oropharyngeal lymphoid enlargement, snoring and fatigue. Overnight polysomnography revealed moderately severe obstructive sleep apnoea (OSA), which was managed successfully with oral appliance therapy with resolution of snoring and daytime fatigue. Structural abnormalities of the upper airways are known to cause OSA. Airway narrowing can result from bony structural abnormalities, nasopharyngeal growth, soft tissue redundancy, macroglossia, malignant and benign growth of the upper aero-digestive tract, and adenotonsilar enlargement. Clinicians should be encouraged to consider a diagnosis of OSA in patients with CLL when they present with symptoms of worsening fatigue.

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Design of a study to investigate the mechanisms of obstructive sleep apnoea by means of drug-induced sleep endoscopy

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2019-0113 ◽

2019 ◽

Vol 57 (9) ◽

pp. 1406-1413

Author(s):

Valeria Bisogni ◽

Giuseppe Maiolino ◽

Giulio Ceolotto ◽

Martino F. Pengo ◽

Rosario Marchese Ragona ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Plasma Catecholamines ◽

Sleep Apnoea ◽

Sleep Endoscopy ◽

Upper Airways ◽

Drug Induced ◽

Chromatography Method ◽

Plasma Aldosterone Concentration ◽

Drug Induced Sleep Endoscopy ◽

Obstructive Sleep

Abstract Background Obstructive sleep apnoea (OSA) is an independent risk factor of hypertension and cardiovascular diseases. Recurrent episodes of upper airways collapse during sleep causing blood oxygen desaturation, hypercapnia, and micro-arousals, are known to activate the sympathetic nervous system (SNS). However, whether changes in the renin-angiotensin-aldosterone system and endothelial activation also occur remains contentious. Methods Based on routine use of drug-induced sleep endoscopy (DISE) for the work-up of OSA patients in our centre, we designed a prospective study to investigate the haemodynamic and humoral changes occurring during the apnoeic episodes reproduced in vivo in the course of DISE. Specifically, plasma aldosterone concentration and renin activity, C-terminal fragment of proendothelin-1, as a marker of endothelial damage, and free plasma catecholamines, will be measured at fixed times during DISE. The activity of catechol-O-methyltransferase (COMT), a key catecholamine-inactivating enzyme that has been scantly investigated thus far owing to the lack of commercially available kits, will be also determined by a newly developed high performance liquid chromatography method, which is herein described. Results and conclusions The aim of this study is to provide novel information on the haemodynamic, hormonal, and SNS changes, and also on COMT activity modification concomitantly occurring during apnoea, thus contributing substantively to the understanding of the pathophysiology of OSA.

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A combined orthodontic / orthognathic approach in the management of obstructive sleep apnoea: Balancing treatment efficacy and facial aesthetics

Journal of Orthodontics ◽

10.1177/1465312520952451 ◽

2020 ◽

Vol 47 (4) ◽

pp. 354-362

Author(s):

Naurine Shah ◽

Peter D Waite ◽

Chung H Kau

Keyword(s):

Obstructive Sleep Apnoea ◽

Orthognathic Surgery ◽

Treatment Plan ◽

Surgical Techniques ◽

Functional Results ◽

Sleep Apnoea ◽

Caucasian Woman ◽

Facial Aesthetics ◽

Airway Function ◽

Obstructive Sleep

Obstructive sleep apnoea (OSA) is a prevalent condition and has been extensively managed with orthognathic surgery using a variety of surgical techniques. This case report describes the successful management of a 56-year-old Caucasian woman with a bimaxillary retrusive profile and macroglossia complicated by OSA and the combined use of orthodontics and orthognathic surgery to improve Apnoea-Hypopnoea Index while maintaining facial aesthetics. The non-extraction treatment plan included: (1) pre-surgical orthodontic treatment to maximise aesthetics and functional occlusion after surgery; (2) maxillomandibular advancement using down fracture of the maxilla (Le Fort 1 osteotomy) with counter-clockwise rotation as well as bilateral sagittal split osteotomy with septoplasty to aid increase in airway function; and (3) post-surgical orthodontic finishing and alignment with self-ligating fixed appliances. Optimum aesthetic and functional results as well as an increase in the airway volume were achieved, without compromising facial aesthetics, with the cooperation of two specialties and the use of state-of-the-art technology during the surgical planning stages.

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