Sleep apnea syndrome: A report of 20 Saudi patients.

Patients with sleep apnea syndrome (SAS) suffer considerable morbidity and increased mortality. The most common symptoms of SAS include excessive daytime sleepiness, nocturnal breath cessation, snoring and gasping sounds. We reviewed the characteristics of 20 Saudi patients with sleep apnea (15 males, five females) who were studied at our tertiary care center in 1992 and 1993. The ages ranged from 15 to 61 years. All were obese. Two each were acromegalic and hypothyroid. Hypertension was noted in seven (35%) patients and one had symptomatic bradycardia. Two (10%) patients presented with recurrent pulmonary emboli and two were involved in multiple road traffic accidents as a result of falling asleep while driving. One male student had poor performance at school. Three patients were known to have chronic obstructive airway disease. Six males and one female were hypercapnic (PCO2; > 6.1 kPa) while 10 patients had hypoxemia (paO2; < 8.0 kPa). Four patients were polycythemic. Pulmonary function tests showed that 15 (75%) had restrictive patterns, three (15%) had obstructive patterns and two (10%) had mixed patterns. A "saw-tooth" pattern was seen in the inspiratory limb of a flow-volume curve in four patients. Daytime polysomnography showed that eight had obstructive sleep apnea, four had central sleep apnea and six had mixed type sleep apnea. Both hypothyroid patients improved with replacement therapy; one acromegalic patient and one patient with tracheal stenosis responded to specific treatment. Nasal positive airway pressure machine (BIPAPtrade mark Resperonics Inc) was effective in relieving apnea and reducing symptoms in five patients. None of the patients were able to lose a substantial amount of weight. All these patients were investigated extensively at different places prior to establishing the diagnosis.

An allergic reaction to intravenous methylprednisolone administration.

A 60-year-old woman with acute asthma developed generalised urticaria and rapidly worsening bronchospasm immediately after IV administration of methylprednisolone sodium succinate. Subsequent skin testing was positive for this, but for no other corticosteroid. Later, both IV dexamethasone during a recurrent attack and oral prednisone for panhypopituitarism were well tolerated. This patient and a review of the literature reveal that corticosteroids are a very rare but important cause of anaphylaxis-like reaction.