Pickwick症候群様症状を呈したCough Syncopeの1例

A CASE OF COUGH SYNCOPE ASSOCIATED WITH SOMNOLENCE AND PERIODIC APNEA DURING SLEEP

緒言

　咳によつて起る失神はCharcot^6）によつてlaryngealvertigoとして記載された。その後欧米には400例以上の症例報告^21），および多くの研究がみられるが，わが国にはこれまで報告例はみられない。

　Cough syncopeとは，重積した激しい咳の発作に引き続いて突然単時間の意識消失を来たすもので，coughsyncopeを呈する患者のほとんどは肥満した外向的性格の中年男性で，愛煙，愛酒，大食などの特徴を揃え，しばしば気管支炎，肺気腫，気管支喘息などの基礎疾患を有する^22）。

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.