Upper Airway Stimulation in a Patient with Amyloidosis of the Tongue

Upper airway stimulation (UAS) is established as a second-line therapy of obstructive sleep apnea (OSA) in failure of overpressure therapy (PAP). The manifestation of a light chain amyloidosis (AL) of the tongue is an important differential diagnosis of macroglossia. After successful chemotherapy of AL, macroglossia often remains as functional respiratory obstruction.

A 74-year-old patient with systemic AL and severe OSA (AHI 45/h) could not tolerate PAP therapy. Suspected cardiac manifestation and participation of the tongue, several chemotherapies were performed with very good response to the AL.

Since no therapeutic alternatives were possible for standard weight (BMI 28 kg/m²), insufficient tooth status and atrophic tonsils, the implantation of the UAS took place after sleep endoscopy in 02/2019. The procedures required complex anesthesiological respiratory management. The exhaustion of setting options of the UAS was necessary to achieve muscular activations of the tongue despite amyloid deposits. In March 2020, symptomatic atrial fibrillation (AF) and inadequate drug treatment were treated with cardioversion, which damaged the UAS impulse generator (IPG). After replacing the IPG 03/2020 showed no other impairment, a good therapy of OSA (AHI 15.1/h) was achieved.

Affected persons with AL are considered to be at risk for OSA through manifestation as cardiovascular disease. Cardioversions can cause implant damage. After exhausting medical therapy, cardioversion should be done with biphasic waveform, minimal current pulse and far distand implant support of the electrodes. In case of possible UAS-malfunction, the telemetric control is recommended by the attending clinic.

Poster-PDF A-1452.PDF

Conflict of interest

Der Erstautor gibt keinen Interessenskonflikt an.

Publikationsverlauf

Artikel online veröffentlicht:
13. Mai 2021