[A 51-year-old patient with arterial hypertension, respiratory insufficiency and polycythemia--an unusual cause of nocturnal sleep-associated breathing disorder].
METHODS
A 51-year-old man without significant previous illness presented with treatment-resistant arterial hypertension, dyspnoea, increased fatigue and headaches. Except for a florid face and fine tremor the physical examination was unremarkable.


METHODS
The chest x-ray showed pulmonary congestion. Blood gas analysis indicated respiratory alkalosis and hypoxaemia (pO2 65.2 mm Hg, pCO2 33.9 mm Hg, pH 7.46) and polycythaemia (haemoglobin 18.1 g/dl, haematocrit 53.5%). There was no evidence of an underlying cardiopulmonary disease. Sleep apnoea screening with an 8-channel recorder was compatible with the central sleep apnoea syndrome (apnoea/hypopnoea index 38/h).


METHODS
In the absence of neurological findings and an underlying medical condition the patient was again questioned. This revealed that in the previous 3 months he had been living and working as a waiter at a height of 3029 m above sea-level, without prior acclimatization. The symptoms and abnormal findings cleared up after a 6-week stay at 800 m.


CONCLUSIONS
At a time when people often quickly move between different altitudes, high-altitude sickness should be included in the differential diagnosis of respiratory failure and the central sleep apnoea syndrome.
Abteilung für Innere Medizin, Krankenhauses Mittersill. chkrabbe@aol.com
C
C
Krabbe
M
M
Hammerer
K
K
Kritzinger
D000532:Altitude Sickness / Q000150:complications* / Q000175:diagnosis; D001772:Blood Cell Count; D001784:Blood Gas Analysis; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011086:Polycythemia / Q000150:complications* / Q000209:etiology; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000150:complications* / Q000209:etiology; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology*
D006454:Hemoglobins
51jähriger Patient mit arterieller Hypertonie, respiratorischer Insuffizienz und Polyglobulie--ungewöhnliche Ursache einer nächtlichen schlafassoziierten Atemstörung.