Abstract
Untreated idiopathic congenital central hypoventilation syndrome (CCHS) is thought to cause infant death within 1–2 months. Here we present an adult patient with CCHS who survived without continuous ventilatory support, despite hypoventilation from early childhood onward. The diagnosis was confirmed at the age of 22 years, when the patient presented with hypoventilation during the night (PaCO<sub>2</sub> 60 mm Hg, PaO<sub>2</sub> 56 mm Hg, pH 7.32 HCO<sup>–</sup><sub>3</sub> 30 mmol/l) but hyperventilation when awake (PaCO<sub>2</sub> 26 mm Hg, PaO<sub>2</sub> 81 mm Hg, pH 7.56, HCO<sup>–</sup><sub>3</sub> 23 mmol/l). The maximal hematocrit was 77%. Despite mental retardation, noninvasive positive pressure ventilation (NPPV) could be successfully established. NPPV-supported ventilation during the night (PaCO<sub>2</sub> 36, PaO<sub>2</sub> 84 mm Hg, pH 7.47, HCO<sup>–</sup><sub>3</sub> 25 mmol/l) reduced hematocrit values (40.6 to 36.8%) over a period of 4 years. In conclusion, long-term survival with CCHS is possible without continuous ventilatory support. Spontaneous improvement of hypoventilation during sleep throughout childhood is possible and hyperventilation during wakefulness may occur in patients with CCHS. CCHS can be managed with NPPV despite mental retardation, even over a long-term period.
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