Two cases of atelectasis due to sleep apnea syndrome after lobectomy

Abstract

Increasing attention has recently been given to sleep apnea syndrome (SAS), but the diagnosis is difficult if there are no subjective symptoms before surgery. Two patients with SAS because of middle lobe atelectasis after lobectomy are presented. Both patients (metastatic lung cancer in case 1 and right lower lung cancer in case 2) underwent right lower lobectomy. Chest radiographs showed increased pleural effusions, and chest CT showed middle lobe atelectasis, on postoperative day POD1 in case 1 and on POD6 in case 2. They showed somnolence and apnea after sleeping, with a decreasing oxyhemoglobin saturation. SAS was suspected, and continuous positive airway pressure mask treatment was started. The radiographs on the next day showed the improvement of atelectasis. On polysomnography, the apnea hypopnea index of case 1 was 89.6, and that of case 2 was 45.8. SAS should be considered as a cause if atelectasis occurs after lobectomy.