A CASE OF HYPERSOMNIA WITH PERIODIC APNEA SIMILAR TO PICKWICKIAN SYNDROME
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The present report deals with a 31-years-old housewife with hypersomnia and enuresis, from which she suffered since childhood. She is 140cm high and 41kg of body weight. She showed neither pulmonary nor circulatory dysfunction during wakefulness. During sleep periodic apnea occurred and it continued throughout nocturnal sleep. The periodic apnea accompanied prominent disturbance of sleep as judged by the EEG pattern. During drowsiness and light sleep apneic period lasted 10 to 33 sec (20 sec in average) and recovery of respiration was always preceded by EEG arousal response with appearance of alpha rhythm or K-complex. In deeper sleep stages recovery of respiration was also accompanied by EEG arousal response but this usually consisted of incomplete K-complex without appearance of alpha rhythm. Thus, within each apneic pericd the EEG pattern changed from that of drowsiness to that of light sleep with spindles or further to that of deep sleep with high voltage slow waves, which was interrupted by EEG arousal response preceding return of respiration. In the paradoxical phase of sleep, apneic period was longest in its duration (28-48 sec) but periodic disturbance of sleep, as was judged from the EEG pattern, was not observed. The above findings are quite similar to those observed by others in patients with Pickwickian syndrome, though accessory symptoms usually attendant to this syndrome (polycythemia, corpulence, etc.) are absent in the present case. Periodic apnea in this patient was of obstructive type. Enuresis occurred a few minutes after awakening from different stages of sleep, when alpha rhythm was observed in the EEG tracings. It is surmised that enuresis in this case might be a result of hypersomnia.
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