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Reversal by Tracheoplasty

Elliot D. Weitzman, MD; Charles P. Pollack, MD; Bernard Borowiecki, MD

Arch Neurol. 1978;35(6):392-395.

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 III, 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.

Author Affiliations
From the Sleep-Wake Disorders Unit, Department of Neurology (Drs Weitzman and Pollack) and Otolaryngology (Dr Borowiecki), Montefiore Hospital and Medical Center; and Albert Einstein College of Medicine Bronx, NY.

Footnotes
Accepted for publication Nov 29, 1977.

Reprint requests to Department of Neurology, Montefiore Hospital and Medical Center, Bronx, NY 10467 (Dr Weitzman).

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