Obstructive Sleep Apnea and Hypopnea Syndrome Originating from an Unusual Anatomical Obstructive Site-A Case Report

罕見解剖構造異常引起阻塞性睡眠呼吸中止症－病例報告

陳鈴宜(Ling-I Chen) ； 王景平(Ching-Ping Wang) ； 黃偉彰(Wei-Chang Huang) ； 吳明峰(Ming-Feng Wu) ； 許正園(Jeng-Yuan Hsu)

《胸腔醫學》 28卷1期 (2013/02) Pp. 51-56

摘要

對於經歷頸部或胸腔手術的患者而言，術後因喉返神經受損引起雙側聲帶麻痺並非少見之併發症。在此病例報告中，一位男性甲狀腺癌病人術後纖維喉鏡檢查發現雙側聲帶麻痺並接受氣切手術。歷經階段性氣切更換與吞嚥訓練後移除氣切。但自氣切移除後，病患開始出現睡眠時打鼾之情況而轉介睡眠門診。經評估後，此病患並無常見引發睡眠呼吸中止症之上呼吸道解剖構造異常。經多頻道睡眠生理檢查顯示有重度阻塞性睡眠呼吸中止症。對於喉部構造異常引起之阻塞性睡眠呼吸中止症目前仍只有少數病例報告發表且治療仍以手術方式為主。我們藉此病例報告提醒對於曾接受頸部或胸腔手術患者新產生之睡眠呼吸中止症候群時，除常見引發之危險因子評估外，纖維喉鏡檢查與肺功能檢查釐清確切阻塞位置是非常重要的。

關鍵字

聲帶麻痺 ； 阻塞性睡眠呼吸中止症

並列摘要

Bilateral vocal cord palsy is not an uncommon complication in patients who have experienced neck or thoracic surgery. We describe a male patient who had a past history of thyroid cancer with mediastinum invasion and recurrent laryngeal nerve impairment. Post-thyroidectomy flexible laryngoscope examination revealed bilateral vocal cord palsy. He was referred to the sleep outpatient services due to the new onset of loud snoring when sleeping following the tracheostomy decannulation. Full-night polysomnography (PSG) showed severe obstructive sleep apnea and hypopnea syndrome (OSAHS), and flow-volume loop revealed variable extra-thoracic upper airway obstruction. The level of larynx abnormality contributing to OSAHS has not been clearly determined until now. We present this case to emphasize that laryngeal examinations and flow-volume loop should be implemented in patients with a history of neck or thoracic surgery and a new onset of loud snoring.

並列關鍵字

vocal cord palsy ； obstructive sleep apnea and hypopnea syndrome