A Case of Nocturnal Stridor with Combined Obstructive Sleep Apnea Caused by Bilateral Vocal Cord Palsy

Abstract

Bilateral vocal cord palsy is an uncommon medical condition to cause nocturnal stridor and obstructive sleep apnea. We describe the case of a man who had been referred to us with a 20-year history of snoring, witnessed apneas, excessive daytime sleepiness, harsh high-pitched stridor during sleep caused by undiagnosed bilateral vocal cord palsy. Nocturnal polysomnography found that his apnea/hypopnea index was 25 and his minimum arterial oxygen saturation level was 88%. He had of a little bit macroglossia. However, enlarged tonsils or other anatomic abnormalities regarding his oral cavity did not occur to him. Our investigation using flexible fiberoptic laryngoscope revealed that he did indeed have nocturnal stridor combined with obstructive sleep apnea (OSA) due to idiopathic bilateral vocal cord paralysis. Tracheostomy was performed under local anesthesia, and his sleep related problems were resolved immediately. During 2 years of follow-up, no recurrence of apnea, snoring was noted. Laryngeal examination should be performed routinely to evaluate the glottis structure and cause of sleep related stridor and OSA. Key words: Sleep, Stridor, Obstructive, Vocal cord paralysis, Laryngoscopy