SECONDARY OBSTRUCTIVE SLEEP-APNEA SYNDROM E IN A PATIENT WITH TRACHEAL STENOSIS AND BILATERAL RECURRENT NERVE PALSY

History and admission findings: A 67-year-old woman complained of mark ed daytime sleepiness, as well as loud snoring and apnoeas during slee p. She was known to have had 3 thyroidectomies for goitre 41, 23 and 1 2 years ago, with known tracheal stenosis and recurrent nerve palsy fo r 11 years. Physical examination revealed marked strider, hoarse voice and slightly enlarged and palpable recurrent right thyroid. Investiga tions: Polysomnography demonstrated a clearly elevated obstructive sle ep apnoea activity (apnoea index: 34/h, apnoea-hypopnoea index: 40/h, desaturation index: 31/h, minimal saturation: 63 %). Selective trachea l imaging showed subglottic tracheal stenosis with an inspiratory lumi nal diameter of 4mm and an expiratory luminal diameter of Smm. Lung fu nction analysis revealed merited flattening of the flow-volume curve a s sign of a functionally effective tracheal stenosis. These findings i ndicated a secondary obstructive sleep apnoea (OSA) due to tracheal st enosis and bilateral recurrent nerve palsy. The patient declined furth er studies, such as bronchoscopy. Treatment and course: As the patient did not want any surgical treatment, nasal continuous positive airway pressure therapy (CPAP) was instituted as a trial. No apnoea occurred at a pressure of 12 mm H3O and this was well tolerated. She has now c ontinued CPAP at home for 12 months and her vigilance was markedly imp roved. Conclusion: Tracheal stenosis or recurrent nerve palsy is a rar e cause of OSA which can be effectively treated by nasal CPAP.