title: Hypersomnia-sleep apnea due to micrognathia. Reversal by tracheoplasty.
abstract: A 67-year-old woman with acquired micrognathia developed severe daytime hypersomnia, loud snoring, nocturnal enuresis, encopresis, and hypertension. A polysomnogram demonstrated 564 sleep apneas, primarily obstructive, recurrent hypoxia, a bradytachycardia, and absent stages III, IV, and REM sleep. Endoscopy during sleep revealed recurrent active closure of the upper pharynx associated with loud snoring. A tracheoplasty was done because of severity of symptoms and failure of conservative therapy. Dramatic improvement in sleepiness and hypertension occurred within 48 hours. On postoperative night 15 a repeated polysomnogram showed only 23 apneas, no hypoxia or bradytachycardia, and long periods of stage II, IV, and REM sleep. Patients with the hypersomnia-sleep apnea syndrome should be provided with a tracheal opening during sleep when severe daytime somnolence, cardiac arrhythmias, and hypertension are present.
mesh_terms: D000368:Aged; D001049:Apnea / Q000209:etiology* / Q000601:surgery; D006970:Disorders of Excessive Somnolence / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D008844:Micrognathism / Q000150:complications* / Q000209:etiology; D011183:Postoperative Complications; D012893:Sleep Wake Disorders / Q000209:etiology*; D012895:Sleep, REM; D013577:Syndrome; D014140:Tracheotomy