Obstructive Sleep Apneas, Cervical Osteophytosis and Sudden Death: A Paradigmatic Case and A Brief Overview of the Literature - Obstructive Sleep Apneas, Cervical Osteophytosis and Sudden Death: A Paradigmatic Case and A Brief Overview of the Literature - Open Access Pub

Obstructive sleep apnea (OSA) syndrome is a common disease characterized by partial or complete collapse of the upper airway during sleep secondary to functional or anatomical factors. The gold standard method for OSA diagnosis is an overnight polysomnogram demonstrating repetitive obstructive apneas and hypopneas during sleep. OSA syndrome is associated with cardiovascular diseases, stroke and rarely with sudden death. OSA and cervical spine osteophytes share some common risk factors, and their coexistence may cause mechanic respiratory obstruction with a severe sleep apnea. We present a brief overview on this syndrome, its links to the cervical spine pathology and their combined effect on a patient presenting with neurological signs who suddenly died before an effective treatment was possible to perform. This case highlights how a rapid deterioration of the functional balance may be possible even when a clinical condition has been present, known and unchanged for a long period of time and the need to treat adequately a not-so-innocuous pathology without an excessive delay. DOI10.14302/issn.2574-4518.jsdr-16-1002 Background Obstructive sleep apnea syndrome is a common disorder characterized by intermittent closure or collapse of the pharyngeal airway, causing apneic episodes and fragmentation of sleep. Its prevalence is estimated to be around 2-4%1. Apnea is defined as a cessation of airflow for at least 10 seconds and is frequently associated with oxygen desaturation; a lesser reduction in airflow is called hypopnea. The gold standard method for OSA diagnosis is an overnight polysomnogram demonstrating repetitive obstructive apneas and hypopneas during sleep. Sleep study measures the apnea/hypopnea index (AHI), which is the number of respiratory events occurring in 1 hour2and the respiratory disturbance index (RDI), that is the sum per hour of episodes of apnea, hypopnea, and respiratory effort-related arousals (RERAs). The American Academy of Sleep Medicine criteria allow to diagnose OSAS according to the presence of AHI or RDI is ≥5 episodes/hour with evidence of respiratory effort during all respiratory events; diagnosis is not better explained by another sleep, medical, or neurological disorder, or medication or drug use; and at least 1 of the following is present: daytime sleepiness, unrefreshing sleep, fatigue, insomnia, or unintentional sleep episodes during wakefulness; patient wakes with breath holding, gasping, or choking; patient's bed partner reports loud snoring, breathing interruptions, or both, during patient's sleep3. OSA is mild if