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Japanese

A CASE OF COUGH SYNCOPE ASSOCIATED WITH SOMNOLENCE AND PERIODIC APNEA DURING SLEEP Jun Ogata 1 , Hiroaki Fujishima 1 , Tsunoru Miyazaki 1 , Masamitsu Kido 2 , Takahito Hirose 2 , Minoru Yoshida 2 , Kotaro Sugiyama 2 1Department of Neurology, Kyushu Kasai Hospital 2Research Institute for Disease of the Chest, Kyushu University, Faculty of Medicine pp.233-241
Published Date 1974/2/1
DOI https://doi.org/10.11477/mf.1406203503
  • Abstract
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A 53-year-old man with cough syncope show-ing obesity, somnolence and periodic apnea duringsleep as seen in the Pickwickian syndrome was presented. Results of physiological observation on this case were described and discussed especially on the neurological aspect.

The generalized slowing of EEG associated with cough syncope was thought to indicate cerebral ischemia. It was postulated that cough syncope occurred chiefly as a result of Valsalva effect by repeated vigorous coughs. Marked tonsillar hyper-trophy of this case was thought to be responsible to the cough syncope, by valve like effect dis-turbing inspiration during paroxysm of coughs and becoming a source of cough reflex.

Alveolar hypoventilation was absent except dur-ing the apneic phases of periodic respiration. The respiratory center showed a depressed ventilatory response to carbon dioxide. The periodic apnea during sleep showed apnea of both obstructive andcentral types. The periodic apnea was thought to have developed by upper air way obstruction during sleep due to obesity and tonsillar hyper-trophy, and secondarily decreased respiratory center sensitivity to carbon dioxide. The tonsillectomy and uvulectomy resulted in significant improvement in somnolence and periodic respiration during sleep, as well as cough syncope. Overnight sleep EEG showing only very light sleep with strikingly periodic apnea improved to moderately deep sleep with almost no apnea after operation.

This is the first case report of cough syncope in Japan. Moreover, such a case showing associ-ation of cough syncope and Pickwickian syndrome-like features can not be found in the world liter-ature.


Copyright © 1974, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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