Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal Hyperostosis
Diffuse Idiopathic Skeletal Hyperostosis (DISH) can cause ossification of ligaments and may affect the spine. We report a case of obstructive sleep apnea in a patient with significant upper airway narrowing secondary to cervical DISH. This patient had an initial apnea-hypopnea index (AHI) of 145 eve...
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| Format: | Article |
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Wiley
2016-01-01
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| Series: | Case Reports in Otolaryngology |
| Online Access: | http://dx.doi.org/10.1155/2016/4906863 |
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| author | Ara Darakjian Ani B. Darakjian Edward T. Chang Macario Camacho |
| author_facet | Ara Darakjian Ani B. Darakjian Edward T. Chang Macario Camacho |
| author_sort | Ara Darakjian |
| collection | DOAJ |
| description | Diffuse Idiopathic Skeletal Hyperostosis (DISH) can cause ossification of ligaments and may affect the spine. We report a case of obstructive sleep apnea in a patient with significant upper airway narrowing secondary to cervical DISH. This patient had an initial apnea-hypopnea index (AHI) of 145 events/hour and was treated with uvulopalatopharyngoplasty, genial tubercle advancement, hyoid suspension, septoplasty, inferior turbinoplasties, and radiofrequency ablations to the tongue base which reduced his AHI to 40 events/hour. He redeveloped symptoms, was started on positive airway pressure (PAP) therapy, and later underwent a maxillomandibular advancement which improved his AHI to 16.3 events/hour. A few years later his AHI was 100.4 events/hour. His disease has gradually progressed over time and he was restarted on PAP therapy. Despite PAP titration, years of using PAP therapy, and being 100 percent compliant for the past three months (average daily use of 7.6 hours/night), he has an AHI of 5.1 events/hour and has persistent hypersomnia with an Epworth Sleep Scale questionnaire score of 18/24. At this time he is pending further hypersomnia work-up. DISH patients require prolonged follow-up to monitor the progression of disease, and they may require unconventional measures for adequate treatment of obstructive sleep apnea. |
| format | Article |
| id | doaj-art-7c3fe17fa4ea49b0bf0abe503392aa80 |
| institution | Kabale University |
| issn | 2090-6765 2090-6773 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
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| series | Case Reports in Otolaryngology |
| spelling | doaj-art-7c3fe17fa4ea49b0bf0abe503392aa802025-02-03T01:30:47ZengWileyCase Reports in Otolaryngology2090-67652090-67732016-01-01201610.1155/2016/49068634906863Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal HyperostosisAra Darakjian0Ani B. Darakjian1Edward T. Chang2Macario Camacho3Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, 1975 Zonal Ave, Los Angeles, CA 90033, USADepartment of Radiology, Southern California Permanente Medical Group, 4867 W. Sunset Blvd, Los Angeles, CA 90027, USADivision of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI 96859, USADivision of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI 96859, USADiffuse Idiopathic Skeletal Hyperostosis (DISH) can cause ossification of ligaments and may affect the spine. We report a case of obstructive sleep apnea in a patient with significant upper airway narrowing secondary to cervical DISH. This patient had an initial apnea-hypopnea index (AHI) of 145 events/hour and was treated with uvulopalatopharyngoplasty, genial tubercle advancement, hyoid suspension, septoplasty, inferior turbinoplasties, and radiofrequency ablations to the tongue base which reduced his AHI to 40 events/hour. He redeveloped symptoms, was started on positive airway pressure (PAP) therapy, and later underwent a maxillomandibular advancement which improved his AHI to 16.3 events/hour. A few years later his AHI was 100.4 events/hour. His disease has gradually progressed over time and he was restarted on PAP therapy. Despite PAP titration, years of using PAP therapy, and being 100 percent compliant for the past three months (average daily use of 7.6 hours/night), he has an AHI of 5.1 events/hour and has persistent hypersomnia with an Epworth Sleep Scale questionnaire score of 18/24. At this time he is pending further hypersomnia work-up. DISH patients require prolonged follow-up to monitor the progression of disease, and they may require unconventional measures for adequate treatment of obstructive sleep apnea.http://dx.doi.org/10.1155/2016/4906863 |
| spellingShingle | Ara Darakjian Ani B. Darakjian Edward T. Chang Macario Camacho Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal Hyperostosis Case Reports in Otolaryngology |
| title | Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal Hyperostosis |
| title_full | Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal Hyperostosis |
| title_fullStr | Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal Hyperostosis |
| title_full_unstemmed | Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal Hyperostosis |
| title_short | Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal Hyperostosis |
| title_sort | refractory obstructive sleep apnea in a patient with diffuse idiopathic skeletal hyperostosis |
| url | http://dx.doi.org/10.1155/2016/4906863 |
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