急性呼吸衰竭伴严重阻塞性睡眠呼吸暂停作为多系统萎缩的早期表现：一例病例报告

文献信息

中文摘要

背景： 睡眠相关呼吸障碍在多系统萎缩（MSA）患者中常见，通常表现为因声带外展麻痹导致的喉鸣；然而，早期出现严重呼吸功能损害罕见。我们报告一例81岁女性MSA患者，在出现喉鸣之前发生了与严重阻塞性睡眠呼吸暂停综合征（OSAS）相关的急性呼吸衰竭。该患者需要气管插管。尽管六天后拔管成功，但夜间高碳酸血症持续存在，需要无创通气。多导睡眠图证实了OSAS的诊断，而喉镜检查显示轻度双侧声带外展麻痹，无喉鸣。本病例强调，在MSA患者中，危及生命的呼吸衰竭可能先于喉鸣出现。

英文摘要

Sleep-related breathing disorders are common in patients with multiple system atrophy (MSA), typically presenting as laryngeal stridor due to vocal cord abductor paralysis; however, severe respiratory impairment in the early stage is rare. We report the case of an 81-year-old woman with MSA who developed acute respiratory failure associated with severe obstructive sleep apnea syndrome (OSAS) preceding stridor. The patient required intubation. Although extubation was successful after six days, nocturnal hypercapnia persisted, necessitating noninvasive ventilation. Polysomnography confirmed the diagnosis of OSAS, while laryngoscopy revealed mild bilateral vocal cord abductor paresis without stridor. This case highlights that life-threatening respiratory failure may precede the development of laryngeal stridor in patients with MSA.