Journal Article

1111 Polycythemia in a Man with Quadraparesis: A Case of Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome

Christopher K Pham, Michael Polmear, Aaron Holley and Jacob F Collen

in SLEEP

Published on behalf of American Academy of Sleep Medicine

Volume 41, issue suppl_1, pages A412-A413
ISSN: 0161-8105
Published online April 2018 | e-ISSN: 1550-9109 | DOI: https://dx.doi.org/10.1093/sleep/zsy063.1110

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Abstract

Introduction

Although several reports demonstrate a link between OHS and secondary polycythemia, less evidence links OSA to polycythemia, likely through intermittent nocturnal hypoxemia. We present a case of a nonverbal patient with quadriparesis and mild OSA who was found to have polycythemia during routine follow-up.

Report of Case

40-year-old chronically disabled male with severe TBI, quadriparesis, and BMI 27 kg/m2 presented for routine Sleep Clinic follow-up. He had a history of mild OSA treated with CPAP (8cmH2O) with excellent adherence and residual AHI < 5 events/h for several years with no change in his condition. His mother reported increased secretions and wheezing for several days. He was at his baseline level of consciousness (awake, non-verbal) with normal vital signs, oxygen saturation 95% at room air, and unchanged exam. CXR demonstrated ill-defined consolidation in both lower lobes. Arterial blood gas showed a primary respiratory acidosis and underlying hypercapnia and hypoxemia (pH=7.38/PaCO2=55/PaO2=66) and CBC was notable for hemoglobin of 19 g/dL. Overnight oximetry on CPAP demonstrated marked hypoxemia with 49% of the recording time at an oxygen saturation of less than 88%. These findings, coupled with neuromuscular weakness and interval weight gain (new BMI 32 kg/m2) suggested concurrent obesity hypoventilation syndrome. Non-invasive ventilation with BiPAP was initiated plus empiric antibiotics for presumed pneumonia and his polycythemia resolved 5 days after starting nighttime BiPAP therapy.

Conclusion

A high index of suspicion for nocturnal hypoventilation is important in non-verbal or severely disabled patients that carry a diagnosis of OSA. Although nocturnal hypoventilation syndromes and sleep disordered breathing are usually multifactorial in such patients, clinicians should remain vigilant as pneumonia or lobar collapse may acutely trigger respiratory decline. Polycythemia may be a late finding in patients with chronic nocturnal hypoxemia and can resolve with non-invasive ventilation.

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Subjects: Neurology ; Sleep Medicine ; Clinical Neuroscience ; Neuroscience

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