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Vol. 43. Issue 8.
Pages 467-471 (January 2007)
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Vol. 43. Issue 8.
Pages 467-471 (January 2007)
Case Report
Treatment of Central Sleep Apnea Syndrome of Multifactorial Origin by Home Ventilatory Support
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Mónica Llombart
Corresponding author
llombart_mon@gva.es

Correspondence: Dra. M. Llombart. Servicio de Neumología. Hospital Universitario San Juan de Alicante. Ctra. Alicante-Valencia, s/n. 03550 San Juan de Alicante. Alicante. España
, Eusebi Chiner, Elia Gómez-Merino, Ada Luz Andreu, Esther Pastor, Ana Camarasa
Servicio de Neumología, Hospital Universitario San Juan de Alicante, Alicante, Spain
Article information

We report the case of a patient with chronic renal failure and primary hyperparathyroidism who developed nonhypercapnic central sleep apnea syndrome (CSAS), which was multifactorial in origin and attributed to metabolic factors. Given an inadequate response to oxygen therapy and continuous positive airway pressure (CPAP) revealed by several polygraph studies, the patient was treated with bilevel positive airway pressure ventilatory support. Three months after treatment commenced, a parathyroidectomy was performed and hemodialysis was initiated. At this point it was observed that the patient no longer experienced somnolence; moreover, polysomnography revealed partial improvement in the CSAS and normalization of ventilatory patterns on application of nasal CPAP at 7 cm H2O. We discuss the pathogenesis of CSAS associated with chronic kidney failure along with the treatment options and conclude that treatment should be customized due to the lack of predictability of patient response.

Key words:
Central sleep apnea syndrome
Chronic renal failure
Home mechanical ventilation

Se describe el caso de una paciente afectada de insuficiencia renal crónica e hiperparatiroidismo primario, que presentó síndrome de apnea central (SAC) no hipercápnico, de origen multifactorial, que se atribuyó a factores metabólicos. Fue tratada inicialmente con soporte ventilatorio bipresión tras comprobar, mediante diversos estudios poligráficos, la respuesta inadecuada a oxigenoterapia y presión positiva continua de la vía aérea (CPAP). Tres meses más tarde, tras paratiroidectomía e inicio de hemodiálisis, se observaron la desaparición de la somnolencia, mejoría parcial del SAC en la polisomnografía y normalización del patrón ventilatorio al aplicar CPAP nasal a 7 cmH2O. Se discute la patogenia del SAC asociado a insuficiencia renal crónica, así como las opciones de tratamiento, que en cualquier caso debe ser individualizado, debido a su respuesta imprevisible.

Palabras clave:
Síndrome de apnea central de sueño
Insuficiencia renal crónica
Ventilación mecánica domiciliaria

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