T. Verse et W. Pirsig, Age-related changes in the epiglottis causing failure of nasal continuous positive airway pressure therapy, J LARYNG OT, 113(11), 1999, pp. 1022-1025
At 65 years of age, a former coal miner, now 72-years-old, developed a prog
ressive loss of concentration with daytime sleepiness and sleep disturbance
s. Work-up in pneumological and medical sleep centres resulted in diagnosis
of chronic obstructive pulmonary disease (COPD), borderline obstructive sl
eep apnoea syndrome and, later, upper airway resistance syndrome. In additi
on, there was evidence of reduced efficiency of sleep. Neither the initial
administration of theophylline nor the later use at night of hyperbaric res
piration led to improvement in the patient's symptoms. Instead, the patient
developed loud snoring, as well as the inability to sleep while in a lying
position.
At age 71 years, otorhinolaryngological examination resulted in findings of
age-related changes in the epiglottis, that completely blocked the hypopha
rynx upon inspiration. Polysomnography, which was possible only in a half-s
eated position, revealed reduction in deep sleep, with a maximum oxygen sat
uration of 77 per cent at an apnoea-hypopnoea index (AHI) of 4.8.
Partial resection of the epiglottis with laser surgery resulted in complete
improvement of diurnal drowsiness and reduced stamina. Sleeping in a supin
e position again became possible. Polysomnography revealed normalization of
sleep architecture, but unchanged, low efficiency of sleep.
This case underscores the importance of an interdisciplinary approach to th
e treatment of sleep-related breathing disorders.