PNEUMOTHORAX AND ITS ASSOCIATION WITH SLEEP APNEA: CASE REPORT

SESSION TITLE: Global Case Report Posters SESSION TYPE: Global Case Reports PRESENTED ON: October 18-21, 2020 INTRODUCTION: Spontaneous pneumothorax (SP) is the presence of air in the pleural space that could become a life-threatening illness. There are many conditions/etiologies that could develop in a spontaneous pneumothorax; such as COPD, CF, infectious diseases (like TB), AIDS, lung malignancy, connective tissue diseases, LAM, among others. There have been also an association between Obstructive Sleep Apnea (OSA) and SP. OSA is a sleep disorder characterized by recurrent collapse of the upper airways during sleep, developing episodes of no ventilation in patients (apneas). CASE PRESENTATION: We present a case of a sixty-four-year-old male with a past medical history significant for tobacco exposure, morbid obesity, obstructive sleep apnea and bullous emphysema who was admitted into the hospital due to dyspnea and left sided chest pain that occurred suddenly, with no history of trauma. Patient with imaging findings of development of a secondary spontaneous pneumothorax. Tube thoracostomy performed but in-patient management complicated with fistula formation and development of severe subcutaneous emphysema. Patient with persistent air leak for 18 days, with spontaneous resolution of pneumothorax and successful discharge. DISCUSSION: There is one previous case report that hypothesized the development of pneumothorax as an early manifestation of OSA. Our case confirms previous association, but the parenchymal effects of OSA, especially in patients like this (with extensive bullous lung disease), have not yet been evaluated. The possibility of an overlap syndrome (OSA-SP) could be emerging. The transmural gradient generated after the reduction in the intrathoracic pressure caused by the decreased in the inspiratory effort against an obstructed upper airway that develop in the hypopneas/apneas episodes; could be the responsible for barotraumas in this population. CONCLUSIONS: The apnea episodes in OSA develop alterations in the intra-thoracic pressure, that could be associated with the possible development of SP; but the pathophysiology is multifactorial and remains poorly understood. It is critical to consider that OSA could be an important predisposing factor for pneumothorax, especially in patient with extensive bullous lung disease. Reference #1: Baykal Tulek, et al. Pneumothorax as an initial manifestation of obstructive sleep apnea syndrome. Sleep Breath (2010) 14:249–251. DOI 10.1007/s11325-009-0313-z DISCLOSURES: No relevant relationships by Christian Castillo Latorre, source=Web Response No relevant relationships by Francisco Del Olmo Arroyo, source=Web Response No relevant relationships by Ilean Lamboy, source=Web Response No relevant relationships by Mariana Mercader-Pérez, source=Web Response No relevant relationships by Yomayra Otero, source=Web Response No relevant relationships by William Rodriguez-Cintron, source=Web Response