Abstract
Obstructive sleep apnea (OSA) is the most common variant of sleep-disordered breathing that often goes undiagnosed. OSA is characterized mainly by anatomical obstruction or partial collapse of upper airways during sleep. The obstruction is multifactorial, and a lesser-known fact is that damage to the pharyngeal plexus during head and neck procedures or placement of hardware in the cervical area can lead to narrowing or collapse of the upper airway. We present such a case of a 59-year-old female who developed new-onset OSA after undergoing anterior cervical discectomy and fusion (ACDF). The severity of OSA worsened with the progression of her rheumatoid arthritis (RA) in the cervical region. This case report aims to raise awareness of such an association among clinicians to enable them to screen appropriate patients for sleep-disordered breathing and treat them accordingly.
Highlights
The onset of obstructive sleep apnea following anterior cervical discectomy and fusion has been published in a retrospective study of 12 patients [1]
We present a case of a new diagnosis of obstructive sleep apnea (OSA) following anterior cervical discectomy and fusion (ACDF) with subsequent worsening caused by rheumatoid arthritis (RA), requiring further instrumentalization affecting the cervical spine
A diagnosis of mild obstructive sleep apnea was made and she was placed on continuous positive airway pressure (CPAP) at a setting of 8 cm H2O following a titration study in the sleep lab
Summary
The onset of obstructive sleep apnea following anterior cervical discectomy and fusion has been published in a retrospective study of 12 patients [1]. A postoperative x-ray of the cervical spine showed an anterior plate and screw fixation in C5-7 with no dynamic instability and very minimal motion with flexion and extension (Figure 2) Following discharge, she had overnight oximetry which showed a mild obstructive sleep apnea pattern (Figure 3). A diagnosis of mild obstructive sleep apnea was made and she was placed on continuous positive airway pressure (CPAP) at a setting of 8 cm H2O following a titration study in the sleep lab Two years later her spinal recovery was complicated with worsening neck pain and numbness in the right upper extremity. She underwent right C6-7 decompressive foraminotomy as well as C4-T2 posterior instrumented fixation using the K2M Caspian® system (Stryker Corp., Kalamazoo, MI) (Figure 4) On her follow-up visit with sleep medicine almost five years later, her husband reported that her OSA had worsened with increased snoring and increased apneic episodes. November 2018 Total sleep time: 440 mins Apnea/Hypopnea Index - 24.7; Supine: 24.7; Off back: 24.7 Mean O2 - 95.3% PLMI - 0.0/hour
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