Korean Journal of Clinical Laboratory Science (대한임상검사과학회지)

Korean Society for Clinical Laboratory Science (대한임상검사과학회)
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Case of Treatment Using Adaptive Servo-Ventilation in a Patient with Central Sleep Apnea after a Lateral Medullary Infarction

외측 연수 경색에 의해 발생한 중추성 수면 무호흡 환자의 자동-적응형 양압기를 사용하여 치료한 경험

  • Kim, Dae Jin (Department of Neurology, Pusan National University Yangsan Hospital) ;
  • Cho, Jae Wook (Department of Neurology, Pusan National University Yangsan Hospital) ;
  • Kim, Hyun Woo (Department of Neurology, Pusan National University Yangsan Hospital) ;
  • Choi, Jeong Su (Department of Health and Safety Convergence Science, Graduate School, Korea University) ;
  • Mun, Sue Jean (Department of Otorhinolaryngology-Head & Neck Surgery, Pusan National University Yangsan Hospital)
  • 김대진 (부산대학교 양산병원 신경과) ;
  • 조재욱 (부산대학교 양산병원 신경과) ;
  • 김현우 (부산대학교 양산병원 신경과) ;
  • 최정수 (고려대학교 대학원 보건안전융합과학과) ;
  • 문수진 (부산대학교 양산병원 이비인후과)
  • Received : 2020.06.30
  • Accepted : 2020.07.08
  • Published : 2020.09.30
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Abstract

Central sleep apnea (CSA) is characterized by respiratory failure of at least 10 seconds without any effort of the chest and abdomen in the absence of upper airway resistance during sleep. In this case, the patient experiences respiratory failure that does not meet the CSA diagnostic criteria and CSA symptoms. Magnetic resonance imaging diffusion-weighted imaging (MRI DWI) scans revealed a lateral medullary infarction. Continuous positive airway pressure (CPAP) was applied as a primary treatment for CSA and respiratory failure. During the titration of CPAP, the apnea-hypopnea index (AHI) and arousal index (AI) were worse than the results before its use (AHI: 42.5/hr→82.8/hr, AI: 21.7/hr→40.8h). As a result, adaptive servo-ventilation (ASV) was chosen as the secondary treatment. Compared to the night-polysomnography results before the ASV treatment, the AHI improved (42.5/hr→8.6/hr). Therefore, ASV is a potential treatment for CSA and respiratory failure in these patients.

중추성 수면 무호흡은 수면 중 상기도 저항이 없을 때 흉부와 복부의 호흡 노력 없이 10초 이상의 호흡부전을 보이는 것이 특징이다. 본 증례에서 뇌자기공명영상 확산 강조 영상검사를 통해 외측 연수 경색의 진단을 받은 환자가 수면다원검사를 통해 중추성 수면 무호흡 진단 기준에 미치지 못하는 호흡부전과 중추성 수면 무호흡이 관찰되었다. 호흡부전과 중추성 수면 무호흡에 대한 일차 치료는 CPAP을 사용하였다. CPAP을 사용한 후 수면다원검사와 이전의 수면다원검사를 비교한 결과 무호흡-저호흡 지수(42.5/hr→82.8/hr)와 각성 지수(21.7/hr→40.8/hr)는 악화되었다. 이에 이차 치료로 ASV를 사용하여 적정압력검사를 시행하였다. 이전의 수면다원검사와 비교한 결과 무호흡-저호흡 지수(42.5/hr→8.6/hr)가 상당히 호전되었다. 이러한 결과로 ASV는 중추성 수면 무호흡과 호흡부전에 대한 좋은 치료방법이 될 수 있다.

Keywords

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