Abstract
A 55-year-old male suffering from general edema with dyspnea visited our hospital. The results of cardiac catheterization and monitoring SpO2 suggested congestive heart failure occurring with sleep apnea syndrome (SAS) with pulmonary hypertension. A polysomnography confirmed severe obstructive sleep (apnea index; 37.1). Although we strongly recommended the use of nasal CPAP or a surgical treatment (uvulopalatopharyngoplasty; UPPP), the patient refused therapy. Six months later, his respiratory status had deteriorated and he was readmitted to our hospital. He had marked hypoxia (PaO2 61.7mmHg) with hypercapnia (PaCO2 101.9mmHg) on admission. Since his consciousness level deteriorated after admission, he underwent endtracheal intubation and tracheostomy. After these treatments sufficiently improved pulmonary hypertension and congestive heart failure, he underwent further UPPP to make closure of the tracheostoma possible. Even after the closure, he showed no sign of dyspnea or congestive heart failure. We discuss the clinical course in this patient with referrence to the literature.
