caa a22 4500 388085428 CHVBK 20180307125228.0 cr unu---uuuuu 161130e199911 xx s 000 0 eng 10.1017/S0022215100145888 doi S0022215100145888 pii (NATIONALLICENCE)cambridge-10.1017/S0022215100145888 Age-related changes in the epiglottis causing failure of nasal continuous positive airway pressure therapy [Elektronische Daten] At 65 years of age, a former coal miner, now 72-years-old, developed a progressive loss of concentration with daytime sleepiness and sleep disturbances. Work-up in pneumological and medical sleep centres resulted in diagnosis of chronic obstructive pulmonary disease (COPD), borderline obstructive sleep apnoea syndrome and, later, upper airway resistance syndrome. In addition, there was evidence of reduced efficiency of sleep. Neither the initial administration of theophylline nor the later use at night of hyperbaric respiration led to improvement in the patient's symptoms. Instead, the patient developed loud snoring, as well as the inability to sleep while in a lying position. At age 71 years, otorhinolaryngological examination resulted in findings of age-related changes in the epiglottis, that completely blocked the hypopharynx upon inspiration. Polysomnography, which was possible only in a half-seated position, revealed reduction in deep sleep, with a maximum oxygen saturation of 77 per cent at an apnoea-hypopnoea index (AHI) of 4.8. Partial resection of the epiglottis with laser surgery resulted in complete improvement of diurnal drowsiness and reduced stamina. Sleeping in a supine position again became possible. Polysomnography revealed normalization of sleep architecture, but unchanged, low efficiency of sleep. This case underscores the importance of an interdisciplinary approach to the treatment of sleep-related breathing disorders. Copyright © JLO (1984) Limited 1999 Epiglottis nationallicence Positive pressure ventilation nationallicence Laser surgery nationallicence Sleep apnoea syndrome nationallicence Verse Thomas Clinic for Otorhinolaryngology, University Clinic, Ulm, Germany. Pirsig Wolfgang Clinic for Otorhinolaryngology, University Clinic, Ulm, Germany. The Journal of Laryngology & Otology Cambridge University Press 113/11(1999-11), 1022-1025 0022-2151 113:11<1022 1999 113 JLO https://doi.org/10.1017/S0022215100145888 text/html Onlinezugriff via DOI 1 other jats NATIONALLICENCE 856 40 https://doi.org/10.1017/S0022215100145888 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Verse Thomas Clinic for Otorhinolaryngology, University Clinic, Ulm, Germany NATIONALLICENCE 700 1- Pirsig Wolfgang Clinic for Otorhinolaryngology, University Clinic, Ulm, Germany NATIONALLICENCE 773 0- The Journal of Laryngology & Otology Cambridge University Press 113/11(1999-11), 1022-1025 0022-2151 113:11<1022 1999 113 JLO CC0 http://creativecommons.org/publicdomain/zero/1.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-cambridge