Acute Aortic Dissection Combined with Obstructive Sleep Apnea Syndrome

(Department of Cardiovascular Surgery, Hiroshima City Asa General Hospital, Hiroshima, Japan)

Tatsuaki Sumiyoshi Hiroshi Ishihara Naomichi Uchida
Masamichi Ozawa
Obstructive sleep apnea syndrome (OSAS) has symptoms such as severe snoring, apneic attack, and daytime hypersomnia due to repeated obstruction of the upper respiratory tract during sleep. The mortality rate due to cardiovascular complications in severe OSAS. We reported 5 cases of OSAS among the acute aortic dissection cases we treated. They were 2 cases of DeBakeyI (cases 1, 2) and 3 cases of IIIb (cases 3, 4, 5). Organ ischemia was recognized in 4 among 5 cases of dissection combined with OSAS. There was 1 case of renal ischemia (case 1), 2 cases of limb ischemia (cases 3, 4), 1 case of visceral and spinal ischemia (case 5). Case 4 was IIIb type dissection with severely compressed true lumen and limb ischemia. The false lumen occluded by combining antihypertensive therapy and continuous positive airway pressure used to OSAS. Case 5 also had a severely compressed true lumen, and visceral ischemia 4 days after the onset. Angiography showed a severly compressed orifice of the true lumen of the celiac artery and superior mesentric artery due to the occluded false lumen. We placed a stent into the orifice of celiac artery transluminally and then patient recovered. There were many dangerous situations such as organ ischemia, and severely compressed true lumen among the cases of dissection combined with OSAS. Marked changes of intrathoracic pressure in apneic attacks may place stress on the thoracic aorta.
@Jpn. J. Cardiovasc. Surg. 33: 152-157 (2004)