Severe obstructive sleep apnoea, aortic dissection and aortopulmonary fistula in a 56-year-old patient with syncope

We present a case of a 56-year-old patient with obstructive sleep apnoea (OSA) presenting with acute decompensated heart failure and signs of cardiogenic shock. Echocardiography and CT imaging led to the diagnosis of acute type A aortic dissection (AD) complicated by aortopulmonary fistula (APF). The patient underwent successful surgical repair with complicated postoperative course including pulseless electrical activity arrest. This case highlights the underappreciated role of untreated OSA as a risk factor for AD. Furthermore, it presents an opportunity to review APFs as a rare complication of AD. We discuss the available evidence linking OSA and AD, review currently reported cases of APF, briefly outline the haemodynamics of this acute left-to-right shunt and discuss management of this rare but deadly complication.

Download Full-text

Is Obstructive Sleep Apnoea Associated with Hypoxemia and Prolonged ICU Stay after Type A Aortic Dissection Repair?

10.21203/rs.3.rs-236766/v1 ◽

2021 ◽

Author(s):

Xin Xi ◽

Yu Chen ◽

Wei-Guo Ma ◽

Jiang Xie ◽

Yong-Min Liu ◽

...

Keyword(s):

Aortic Dissection ◽

Obstructive Sleep Apnoea ◽

Multivariable Analysis ◽

Type A ◽

Sleep Apnoea ◽

Prognostic Impact ◽

Type A Aortic Dissection ◽

Icu Stay ◽

Obstructive Sleep ◽

Prolonged Icu Stay

Abstract Background : Although obstructive sleep apnoea (OSA) is prevalent among patients with aortic dissection, its prognostic impact is not yet determined in patients undergoing major vascular surgery. We aimed to investigate the association of OSA with hypoxemia and with prolonged intensive care unit (ICU) stay after type A aortic dissection (TAAD) repair. Methods: This study enrolled 83 patients who underwent TAAD repair. OSA diagnosis was confirmed by a preoperative STOP-BANG questionnaire and a sleep test performed within 90 days postoperatively. OSA was defined as an apnoea hypopnea index (AHI) of ≥15/h, while an AHI of >30/h was defined severe OSA. Hypoxemia was defined as an oxygenation index (OI) of <200 mmHg, 6 h postoperatively and prolonged ICU referred to an ICU stay of >72 h. Multivariable analysis was performed to assess the association of OSA with hypoxemia and prolonged ICU stay. Results: OSA was diagnosed in 41 patients (49.4%), which was consistent with the detection by using a preoperative STOP-BANG score of ≥4 (Kappa=0.424, P<0.01). Hypoxemia occurred postoperatively in 56 patients (67.5%). Postoperatively hypoxemia developed mostly in OSA patients (52.4% vs. 83.0%, P<0.01), and particularly in those with severe OSA ( 52.4% vs. 90.5%, P<0.01). The postoperative OI could fairly predict a prolonged ICU stay (area under the curve, 0.719; 95% CI 0.595-0.843; P=0.002). Severe OSA was a predictor of both postoperative hypoxemia (odds ratio [OR] 6.65; 95% CI 1.56-46.26, P<0.01) and prolonged ICU stay (OR 5.58; 95% CI 1.54-20.24, P<0.01). Conclusions: OSA was common in patients with TAAD. Severe OSA was predictive of hypoxemia and prolonged ICU stay after TAAD repair. The STOP-BANG score may offer diagnostic clues to OSA in patients with TAAD.

Download Full-text

Untreated severe obstructive sleep apnoea and development of acute aortic dissection

BMJ Case Reports ◽

10.1136/bcr.02.2012.5741 ◽

2012 ◽

Vol 2012 (jun21 1) ◽

pp. bcr0220125741-bcr0220125741 ◽

Cited By ~ 2

Author(s):

T. Inami ◽

Y. Seino ◽

K. Mizuno

Keyword(s):

Aortic Dissection ◽

Obstructive Sleep Apnoea ◽

Acute Aortic Dissection ◽

Sleep Apnoea ◽

Obstructive Sleep

Download Full-text

Untreated obstructive sleep apnoea as a therapeutic target in acute aortic dissection

BMJ Case Reports ◽

10.1136/bcr-2012-006843 ◽

2012 ◽

Vol 2012 (oct19 1) ◽

pp. bcr2012006843-bcr2012006843 ◽

Cited By ~ 1

Author(s):

T. Inami ◽

Y. Seino ◽

R. Bessho ◽

K. Mizuno

Keyword(s):

Aortic Dissection ◽

Obstructive Sleep Apnoea ◽

Therapeutic Target ◽

Acute Aortic Dissection ◽

Sleep Apnoea ◽

Obstructive Sleep

Download Full-text

Dislocation of the inferior turbinates: a rare complication of nasal surgery, presenting as obstructive sleep apnoea

The Journal of Laryngology & Otology ◽

10.1017/s0022215111001320 ◽

2011 ◽

Vol 125 (8) ◽

pp. 859-860

Author(s):

V Gupta ◽

H Singh ◽

M Gupta ◽

S Singh

Keyword(s):

Nasal Obstruction ◽

Obstructive Sleep Apnoea ◽

English Language ◽

Rare Complication ◽

Sleep Apnoea ◽

Nasal Surgery ◽

Obstructive Sleep ◽

History Of ◽

One Year ◽

Language Literature

AbstractObjective:We report a very rare complication of nasal surgery: dislocation of the inferior turbinates into the nasopharynx, presenting as sleep apnoea and persistent nasal obstruction.Case report:A 56-year-old woman presented with a history of obstructive sleep apnoea for one year and nasal obstruction for seven years. She had undergone nasal surgery one year previously. Non-contrast computed tomography of the nose and paranasal sinuses showed a mass near the posterior choana on both sides, confirmed by nasal endoscopy. The displaced turbinates were removed, after resecting their attachment at the posterior choanae, and the patient's symptoms were relieved.Conclusion:This is a very rare complication of nasal surgery; to the best of our knowledge, we report only the second published case in the English language literature. We suggest that such cases be closely followed up post-operatively.

Download Full-text