1/2. Successful diaphragmatic pacing for idiopathic alveolar hypoventilation.We describe the case of a 17-year-old woman noted to have idiopathic alveolar hypoventilation, with multiple intensive care Unit (ICU) admissions because of acute respiratory failure (ARF) due to respiratory infections. After two years of diaphragmatic pacing arterial blood gases have substantially improved, without obstructive apnoea. Signs of right ventricular enlargement and pulmonary hypertension have decreased. Morning headache and diurnal somnolence have disappeared, and she is also able to perform more physical and mental activity, allowing her to enjoy a better quality of life.- - - - - - - - - - ranking = 1keywords = apnoea (Clic here for more details about this article) |
2/2. Central sleep apnoea in arnold-chiari malformation: evidence of pathophysiological heterogeneity.We report on the case of two young patients with type I arnold-chiari malformation (ACM), as revealed by a central sleep apnoea (CSA) syndrome without any other neurological defect. Case 1 was a 14-yr-old male patient, who developed severe alveolar hypoventilation and needed long-term mechanical ventilation via a tracheostomy. Case 2 was a 39-yr-old male patient, who developed features suggestive of sleep apnoea and responded to nasal continuous positive airway pressure ventilation despite the central type of apnoeas. These two cases illustrate the different pathophysiological mechanisms involved in CSA, namely a blunted chemical drive (in hypercapnic patients) and an increased chemical drive, which destabilizes the breathing pattern during sleep (in normo/hypocapnic patients). Central sleep apnoea can be the initial manifestation of arnold-chiari malformation and can lead to a life-threatening condition.- - - - - - - - - - ranking = 8keywords = apnoea (Clic here for more details about this article) |