Critical Oxygen Desaturation from Obstructive Sleep Apnea

Doh-Eui Kim, Kwang Ik Yang, Saeromi Kim, Hyung Geun Oh, Du Shin Jeong, Hyung-Kook Park
2014 Journal of Korean Sleep Research Society  
The risk of cardiac-induced sudden death peaks in the general population from 6:00 AM to 12:00 noon, 1 but in people with obstructive sleep apnea (OSA), the peak in cardiacinduced sudden death occurs during sleep. 2 OSA is characterized by recurrent upper airway collapse associated with arousal and/or oxygen desaturation. Although most of OSA is a chronic illness, some patients may be in particularly critical condition due to acute cardiopulmonary failure. 3 In this report, we describe a
more » ... with OSA who experienced unexpected critical oxygen desaturation during diagnostic polysomnography. Case Report A 53-year-old man was evaluated by the emergency department for dysarthria and lethargy. He was fully conscious and showed no focal neurologic sign, except slurred speech and mild gait instability. He underwent brain magnetic resonance imaging with angiography to exclude acute stroke, but no abnormalities were detected. Several hours later, after the patient was hydrated, the dysarthria and a gait instability improved, but he continued to be lethargic and fatigued. On further in-terview, he had no specific medical history except a long history of habitual snoring, witnessed apnea, and nocturia. Body mass index was 23.4 kg/m 2 . He was a current smoker of 60 pack-years. He denied the any use of drugs or hypnotics, but reported alcohol consumption. The patient usually consumed alcohol twice weekly; however he reported recent stress and consumed two bottles of Soju (Korean wine) everyday for 4 days (19% alcohol per 360 mL bottle). One day after admission, a polysomnography was performed and documented severe OSA, with an apnea-hypopnea index of 44.7. There were recurrent obstructive hypopnea or apnea lasting 15 to 100 s, and the oxygen saturation showed a stepwise decrease (94% to 67%, 71% to 67%, 66% to 62%, and 65% to 47%) over 5 hours since the beginning of the study (Fig. 1) . The oxygen desaturation was not accompanied by any electrocardiographic abnormality, though a shortened R-R interval was observed. The electroencephalography did not show any arousal response. The sleep technician shook the patient to awake him, but the patient remained poorly responsiveness for approximately one minute. The patient appeared to be in a state of deep sleep. Finally, he woke up and recovered alert consciousness, and the respiratory event was terminated. We prescribed continuous positive airway pressure (CPAP) with 8 cmH2O after CPAP titration but the patient was not compliant. We lost follow-up after discharge. Obstructive sleep apnea (OSA) is characterized by recurrent upper airway collapse associated with arousal and/or oxygen desaturation. Although OSA is primarily a chronic illness, patients' condition may deteriorate to critical owing to acute cardiopulmonary failure. A 53-year-old man without specific medical history except OSA experienced a critical oxygen desaturation during diagnostic polysomnography accidently. He was exhausted by stress and heavy consumption of alcohol in those days. Untreated OSA can cause respiratory failure when sudden cardiopulmonary failure occurs during sleep, even if patients have no specific medical history. J Korean Sleep Res Soc 2014;11(2):66-68
doi:10.13078/jksrs.14012 fatcat:v4ixagug35eidi2djdmdyw24ve