title: Severe mixed sleep apnea after bilateral lung transplantation in a cystic fibrosis patient: a case report.
abstract: BACKGROUND
  Lung transplantation is the only treatment for end-stage lung disease in selected patients. After lung transplantation, patient recovery is often slow owing to severe underlying diseases in the patient producing hypoxemia before, during, and after surgery, as well as infections and rejection episodes. Postoperative breathing and ventillatory disorders are also associated with diaphragmatic dysfunction and/or phrenic nerve damage.
  
  
  METHODS
  Herein we have reported a case of a 35-year-old man undergoing bilateral lung transplantation owing to worsening of chronic respiratory failure from cystic fibrosis. After uncomplicated surgery, weaning was delayed due to nighttime dyspnea and hypoxemia attributed to diaphragm dysfunction. After improvement of diaphragm function, the symptoms persisted, requiring noninvasive nocturnal ventilatory support. Polysomnography confirmed severe mixed sleep apnea.
  
  
  RESULTS
  Effective treatment with noninvasive bi-level positive airway pressure spontaneous/timed mode (BiPAP S/T) ventilation during the nights rendered the patient symptom free. Polysomnography confirmed successful treatment.
  
  
  CONCLUSIONS
  Disordered breathing while sleeping is common after solid organ transplantation. BiPAP S/T ventilator therapy was effective to the treat dominantly central sleep apnea in our patient.
authors.affiliation: Department of Pulmonology, Semmelweis University, Budapest, Hungary.
authors.forename: L
authors.initials: L
authors.lastname: Kunos
authors.forename: Z
authors.initials: Z
authors.lastname: Kováts
authors.forename: G
authors.initials: G
authors.lastname: Muraközy
authors.forename: Z
authors.initials: Z
authors.lastname: Süttö
authors.forename: A
authors.initials: A
authors.lastname: Bohács
authors.forename: K
authors.initials: K
authors.lastname: Czebe
authors.forename: G
authors.initials: G
authors.lastname: Lang
authors.forename: F
authors.initials: F
authors.lastname: Rényi-Vámos
authors.forename: W
authors.initials: W
authors.lastname: Klepetko
authors.forename: V
authors.initials: V
authors.lastname: Müller
mesh_terms: D000328:Adult; D003550:Cystic Fibrosis / Q000150:complications / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D017286:Polysomnography; D011175:Positive-Pressure Respiration; D012131:Respiratory Insufficiency / Q000209:etiology / Q000601:surgery*; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents