Sleep Medicine and Psychophysiology (수면정신생리)

KOREAN ACADEMY OF SLEEP MEDICINE (대한수면의학회)
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A Case of Rapidly Developed Obesity Hypoventilation Syndrome in a Patient with Kyphoscoliosis

척추후측만증 환자에서 급속히 진행된 비만성 저환기 증후군 1례

  • Kim, Min Young (Department of Internal medicine, College of Medicine, St. Paul's Hospital, The Catholic University of Korea) ;
  • Jeong, Jee Sun (Department of Internal medicine, College of Medicine, St. Paul's Hospital, The Catholic University of Korea) ;
  • Jang, Yu Na (Department of Internal medicine, College of Medicine, St. Paul's Hospital, The Catholic University of Korea) ;
  • Go, Se-eun (Department of Internal medicine, College of Medicine, St. Paul's Hospital, The Catholic University of Korea) ;
  • Lee, Sang Haak (Department of Internal medicine, College of Medicine, St. Paul's Hospital, The Catholic University of Korea) ;
  • Moon, Hwa Sik (Department of Internal medicine, College of Medicine, St. Paul's Hospital, The Catholic University of Korea) ;
  • Kang, Hyeon Hui (Department of Internal medicine, College of Medicine, St. Paul's Hospital, The Catholic University of Korea)
  • 김민영 (가톨릭대학교 의과대학 내과학교실) ;
  • 정지선 (가톨릭대학교 의과대학 내과학교실) ;
  • 장유나 (가톨릭대학교 의과대학 내과학교실) ;
  • 고세은 (가톨릭대학교 의과대학 내과학교실) ;
  • 이상학 (가톨릭대학교 의과대학 내과학교실) ;
  • 문화식 (가톨릭대학교 의과대학 내과학교실) ;
  • 강현희 (가톨릭대학교 의과대학 내과학교실)
  • Received : 2015.05.06
  • Accepted : 2015.06.12
  • Published : 2015.06.30
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Abstract

Obesity hypoventilation syndrome (OHS) is characterized by severe obesity, excessive daytime sleepiness, hypoxemia and hypercapnea. Because OHS mimics pulmonary hypertension or cor pulmonale, clinicians should recognize and treat this syndrome appropriately. A 58-year-old female visited the emergency room because of dyspnea. She was obese and had kyphoscoliosis. The patient also experienced snoring, recurrent choking during sleep and daytime hypersomnolence which worsened after gaining weight in the recent year. The arterial blood gas analysis showed she experienced hypoxemia and hypercapnea not only during nighttime but also daytime. We suspected OHS and the patient underwent polysomnography to confirm whether obstructive sleep apnea was present. During the polysomnography test, sleep obstructive apnea was observed and apnea-hypopnea index was 9.2/hr. The patient was treated with bilevel positive airway pressure therapy (BiPAP). After BiPAP for 4 days, hypoxemia and hypercapnia were resolved and she is currently well without BiPAP. We report a case successfully treated with clinical improvement by presuming OHS early in a patient who had typical OHS symptoms, even while having other conditions which could cause hypoventilation.

비만성 저환기 증후군은 체질량지수 $30kg/m^2$ 이상의 비만 환자에서 낮 동안의 저산소혈증 및 고탄산혈증($PaCO_2$ 45 mmHg 이상, $PaO_2$ 70 mmHg 미만) 소견을 보이는 질환으로 90% 이상에서 무호흡-저호흡 지수가 시간 당 5회 이상인 폐쇄성 수면 무호흡이 동반되어 나타난다. 특히 고탄산혈증을 유발할 수 있는 심한 폐쇄성 환기장애나, 간질성 폐질환 혹은 심한 흉벽질환 및 신경근육질환을 배제하는 것이 진단에 필수적이나, 임상적으로 비만성저환기 증후군의 양상을 보인다면 조기에 질환을 의심하는 것이 예후에 매우 중요한 영향을 끼친다. 비만성 저환기 증후군 치료의 목표는 체중감소 및 폐쇄성 수면무호흡의 치료, 고탄산혈증과 저산소혈증의 개선으로 산소치료, 경비적 지속적 상기도 양압술, 비침습적 양압 환기요법 등으로 치료 효과를 얻은 증례들이 보고되어 있다. 특히 만성 호흡 부전의 급성 악화가 동반 환자이거나, 지속적 상기도 양압술로 치료가 실패한 환자, 폐쇄성수면무호흡을 동반하지 않은 비만성저환기 환자의 경우에는 이단 상기도 양압술을 적용하여 더 효과적인 치료 결과를 기대할 수 있다. 저자들은 폐포저환기를 유발할만한 다른 질병이나 상태를 가진 환자의 경우에도 중증 비만, 코골이 및 수면 중 무호흡, 낮 동안의 저산소혈증 및 고탄산혈증 등 비만성저환기증후군의 특징적 임상 양상에 근거하여 조기에 비만성저환기 증후군을 의심하였고 이에 대한 평가를 진행하여 이단 상기도 양압 치료를 통해 치료 효과를 거두고 환자의 예후에 매우 큰 영향을 끼치는 것을 경험하였기에 보고하는 바이다.

Keywords

References

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