Postoperative secondary aggravation of obstructive sleep apnea-hypopnea syndrome and hypoxemia with bilateral carotid body tumor: A case report

Table 1 Clinical features of the patient

A 39-year-old man, Han nationality
Basic data
Height, 168 cm; body weight, 86 kg; BMI, 30.4; blood pressure, 160/100 mmHg. No significant change in body weight occurred before and after the surgery
Symptoms
Snoring; apnea; labored breathing; occasional arousal; mental fatigue during the daytime; frequent hypersomnia; inability to work
Sign
Cyanotic lips; conjunctival congestion; mouth deviation to the left; and shallow nasolabial fold. The extended tongue was left-deflected. The tonsil was enlarged (grade I), and the body and base of the tongue and soft palate showed hypertrophy. The Friedman stage was type III. The muscle strength of the four limbs was normal. No dyspnea and three concave signs were noted. The Epworth hypersomnia scale (ESS) scored 21 points. The breath sounds of both lungs were clear, and the heart rhythm was regular. No pathological murmurs were heard
History of disease
No family history of CBT; No alcohol or tobacco; No previous history of hypertension or lung and cerebrovascular diseases. Previously, he had snoring and mouth breathing at night, but no apnea and arousal caused by labored breathing. He had a 10-yr history of anxiety, mania, and insomnia aggravated after CBT surgery
Drugs
Risperidone tablets (4 mg qd); sodium valproate (0.2 g bid); quetiapine (50 mg qd); and nifedipine sustained-release tablets (20 mg bid)

BMI: Body mass index; CBT: Carotid body tumor.

Table 2 Polysomnography results

Polysomnography results
Sleep date: Ratio of each sleep stage/TST
T1	46.2%
T2	31.2%
T3	3.2%
REM	19.4%
Apnea
AHI	22.3 times/h
Obstructive sleep apnea	106 times; Maximum duration, 192 s
Sleep microarousal index	25.3 times/h
SpO2
Lowest awake SpO2	76%
Lowest sleep SpO2	36%
Total time of SpO2 below 90%/TST	30.4%

TST: Total sleep time; REM: Rapid eye movement; AHI: Apnea–hypopnea index; SpO₂: Saturation of pulse oximetry.