Rapid Reduction of Antihypertensive Medications and Insulin Requirements After Tracheostomy in a Patient With Severe Obstructive Sleep Apnea Syndrome

Abstract

O bstructive sleep apnea syndrome (OSA) affects 2-4% of the general population. 1 Irrespective of the type of sleep apnea (central versus obstructive), epidemiologic studies have indicated its independent association with hypertension 2 and cardiovascular disease. 3 Also, there is emerging evidence suggesting that sleep disordered breathing (SDB) has an association with fasting hyperglycemia, insulin resistance, and type 2 diabetes mellitus. 4,5 The impact of tracheostomy for severe obstructive sleep apnea syndrome on glycemic control has not been previously reported. CASE REPORTRR is a 58-year-old African American male with history of longstanding hypertension, obesity, type 2 diabetes mellitus, chronic kidney disease, congestive heart failure, sinus node dysfunction status post permanent pacemaker placement, coronary artery disease, and severe obstructive sleep apnea. He had a body mass index of 32. His baseline blood pressures were in the range of 140-160 mm Hg systolic and 70-90 mm Hg diastolic.An overnight sleep study prior to admission documented severe OSA, with an apnea-hypopnea index (AHI) of 54/hr and oxygen desaturation to 66%. He failed continuous positive airway pressure titration and was subsequently titrated to a bilevel (BiPAP ® ) setting of 15/9 cms of H 2 0 with 3 liters/minute of oxygen. Despite

Maxillomandibular Advancement and Tracheostomy for Morbidly Obese Obstructive Sleep Apnea

“…A total of 495 potentially relevant tracheostomy studies were screened for relevance, 47 articles were downloaded for detailed evaluation, and 2 were added after reviewing references, for a total of 49 full‐text articles obtained 6,12,13,116–161 . After detailed evaluation, it was determined that 31 articles did not report polysomnographic or quantitative sleepiness data, and these were excluded from meta‐analysis.…”

Tracheostomy as Treatment for Adult Obstructive Sleep Apnea

“…4,5 Other studies have also demonstrated that tracheostomies successfully decrease systemic hypertension. [6][7][8][9][10] In addition, there is a case study that demonstrated a significant decrease in insulin requirement 9 days after a tracheostomy was performed. 10 Tilkian et al and other studies have demonstrated that tracheostomies improved cardiac arrhythmia control and in some cases even allowed for reversal.…”

“…Later, Lugaresi et al and Coccagna et al described treating patients with hypersomnia and periodic breathing with tracheostomies who subsequently demonstrated complete resolution of hypersomnia, normalization of systemic and pulmonary pressures, and normalization of blood gas values . Other studies have also demonstrated that tracheostomies successfully decrease systemic hypertension . In addition, there is a case study that demonstrated a significant decrease in insulin requirement 9 days after a tracheostomy was performed .…”

“…[6][7][8][9][10] In addition, there is a case study that demonstrated a significant decrease in insulin requirement 9 days after a tracheostomy was performed. 10 Tilkian et al and other studies have demonstrated that tracheostomies improved cardiac arrhythmia control and in some cases even allowed for reversal. 8,11,12 Since these early studies, there have been several other case reports and case series that have demonstrated the effectiveness of tracheostomies as a treatment for OSA.…”