Obstructive Sleep Apnoea Secondary to Superior Vena Cava Thrombosis in a Patient with Activated Protein C Resistance

• Published in: Somnologie : Schlafforschung und Schlafmedizin = Somnology : sleep research and sleep medicine 2002-12, Vol.6 (4), p.173-175
• Main Authors: Schulz, Richard, Fegbeutel, Christine, Hackstein, Nils, Seeger, Werner
• Format: Article
• Language: English
• Subjects: activated protein C resistance; APC‐Resistenz; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Medical sciences; obstructive sleep apnoea; obstruktive Schlaf‐Apnoe; Proteins; Sleep apnea; superior vena cava thrombosis; Thrombose der oberen Hohlvene; Thrombosis
• ISSN: 1432-9123; 1439-054X
• DOI: 10.1046/j.1439-054X.2002.02196.x

Summary Question of the Study Only five cases of superior vena cava (SVC) thrombosis as a cause of obstructive sleep apnoea (OSA) have as yet been reported. In this study, we aimed to describe an additional case and to review the literature on this subject. 
Patients and Methods Based on the medical records, the case history of a 58‐year‐old man with OSA due to SVC thrombosis is presented. Furthermore, PubMed articles were browsed with the search items ‘sleep apnoea’ and ‘superior vena cava thrombosis’. 
Results The patient complained of the development of facial swelling and plethora during the previous 2 months. Furthermore, he reported the recent onset of snoring and excessive daytime sleepiness. Computed tomography of the thorax and mediastinal phlebography showed SVC thrombosis. Polysomnography demonstrated moderate to severe OSA. The cases of OSA secondary to SVC thrombosis already reported in the literature were mainly caused by mediastinal tumours compressing the SVC. In the present case, we found activated protein C (APC) resistance as the underlying disease. From the literature, it is known that therapies aimed at recanalization or relief of the SVC might lead to reversal of the OSA. In our patient, recanalization of the SVC was not possible and thus he had to be treated by continuous positive airway pressure therapy. 
Conclusion In summary, we report on the rare occurrence of OSA due to SVC thrombosis. In the present case we found APC resistance as the underlying disease, which has not yet been reported in the literature. Zusammenfassung Fragestellung Nur fünf Fälle einer obstruktiven Schlaf‐Apnoe (OSA) infolge einer Thrombose der oberen Hohlvene (superior vena cava; SVC) sind bisher beschrieben worden. In dieser Fallstudie möchten wir einen weiteren Fall vorstellen und eine Literaturübersicht zu diesem Syndrom geben. 
Methodik Basierend auf den Krankenakten wird der Krankheitsverlauf eines 58‐jährigen Patienten mit OSA infolge einer SVC‐Thrombose dargestellt. Weiterhin wurde PubMed mit den Suchbegriffen „sleep apnoea” und „superior vena cava thrombosis” durchsucht. 
Ergebnisse Der Patient litt unter einer Schwellung und Plethora des Gesichtes seit ungefähr zwei Monaten. Weiterhin gab er an, seit kurzem zu schnarchen und sich tagsüber müde zu fühlen. Ein Thorax‐CT und eine Mediastinalphlebographie zeigten eine SVC‐Thrombose. Polysomnographisch wurde eine mittel‐ bis höhergradige OSA gefunden. Bei den in der ­Literatur dokumentierten Fällen war d