It is likely that there was significant hypoventilation secondary to the vocal cord paralysis with increased resistance in the larynx in these patients. Both patients had excessive daytime sleepiness. These patients were started on nasal CPAP with improvement of their symptoms. Both patients had dysphagia and complained of stridor with exercise.
Of the remaining two patients, one (No. 12) had symptoms of morning headaches, nausea, vomiting, excessive daytime sleepiness, ankle edema, and fatigue. Studies demonstrated mixed apnea that was severe in REM sleep. This patient was started on nasal CPAP with a slight reduction in the number of episodes. The headaches were ameliorated, but she refused long-term treatment.
The last patient (No. 13) had severe mixed apnea. She could not be maintained on CPAP because of continuing hypoventilation, and therefore was started on nasal mask ventilation utilizing the same techniques as the patients in group 1 (Table 4).
Six of the patients have now been receiving mechanical ventilation for a mean of 9.3 months. Because the patients were no longer reliant on rocking beds, in several cases, they were able to travel extensively for the first time in over three decades. Two patients previously unable to function at work were able to continue employment.
Table 4—Ventilator Settings
|PatientNo.||Delivered Vt, ml||RR||I/ERatio||Flow Rate, LPM||
|Patients Mean Airway Pressure, cmH,0||
|Patients Actual Vt, ml|