Continuous Positive Airway Pressure Therapy and Tracheostomy for Multiple System Atrophy Accompanied by Sleep Apnea-hypopnea Syndrome

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Background. In multiple system atrophy (MSA) patients, a variety of sleep-related respiratory disturbances, including sleep apnea-hypopnea, are frequently manifested. Both nasal continuous positive airway pressure (CPAP) therapy and tracheostomy have been shown to be effective to treat sleep-related breathing disorders in patients with MSA. Case. A 62-year-old man with MSA accompanied by sleep apnea-hypopnea syndrome and marked obesity was admitted because of gradual worsening daytime sleepiness, fatigue and snoring. Arterial blood gas analysis showed hypoxemia and hypercapnia. Laryngoscopy revealed vocal cord abductor paralysis. He was first treated by CPAP therapy. Next, tracheostomy was performed to avoid sudden death due to vocal cord abductor paralysis. Conclusion. CPAP therapy and subsequent tracheostomy gradually improved daytime hypoxia and hypercapnia as well as sleep desaturation, suggesting that oxygen desaturation due to sleep disordered breathing and obesity may partly contribute to the pathogenesis of alveolar hypoventilation in the present case.
日本呼吸器内視鏡学会の論文
2004-11-25