Upper Airway Obstruction in Obese Patients with Sleep Disturbance and Somnolence

Abstract

In three obese patients with sleep disturbance and somnolence, upper airway obstruction appeared to play the primary pathophysiologic role. The somnolence in these patients was caused by sleep deprivation. Obstruction of the upper airway occurred, airflow ceased, but ineffective thoracoabdominal respiratory efforts persisted. Hypoxia ensued, resulting in electroencephalographic arousal and resumption of effective respirations; thus a cycle of periodic respirations was established. Alveolar hypoventilation, except during the apneic phases of periodic respirations, need not be present in these patients. The clinical and pathophysiologic manifestations can be ameliorated by establishing an airway. In one patient symptoms were abolished by permanent tracheostomy. When the tracheostomy was occluded 1 year later, periodic apnea and sleep disturbances recurred. All obese patients with sleep disturbance or somnolence should be evaluated for upper airway obstruction.