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Correspondence to Gregory Paul Stimac, [email protected]
Background
Obstructive sleep apnoea (OSA) is caused by upper airway obstruction leading to airflow limitation during sleep. Both structural and functional factors are involved in its pathogenesis. Facial anthropometric studies have shown overbite, micrognathia, high-arched palate and mid-face hypoplasia to be some of the structural causes of OSA. Soft tissue abnormalities involving the tongue with macroglossia, floppy soft pallet, pharyngeal wall collapse and soft tissue growths all play roles in airway obstruction during sleep. Dynamic functional changes with loop gain reduction in genioglossus muscle abnormality accounts for functional reasons for airway calibre reduction during sleep. Adenoidal and tonsillar enlargements secondary to recurrent infection is a usual cause of airway obstruction in childhood.1 In adults, oropharyngeal lymphoproliferation secondary to lymphoid disorders has been reported as a cause of OSA with resolution of symptom after treatment of the underlying lymphoma and reduction in lymph node size. Patients with chronic lymphocytic leukaemia (CLL) and oropharyngeal lymphatic enlargement presenting with OSA as an initial presentation or developing OSA through the course of the clinical illness has been rarely reported in the past.2 3 We present a patient with CLL who has been managed with watchful waiting and whose course is complicated by development of OSA secondary to lymphatic enlargement of the oropharyngeal lymph nodes with profound fatigue. CLL patients with oropharyngeal and cervical lymphadenopathy should be monitored for development of OSA when symptoms of snoring and fatigue develop in the course of their disease.
Case presentation
A 69-year-old Caucasian woman was diagnosed with CLL in December 2015. She had stage 1 (Rai System) with stable haematological parameters (table 1), for which she was closely followed by her haematologist. In 2015, she presented to the clinic with significant enlargement of lymph nodes around her neck and a sense of airways narrowing. In the years prior to her initial visit, she had been noted to snore intermittently and was observed to have pauses in her breathing during sleep. She reported significant cervical and axillary lymphadenopathy in addition to tonsillar enlargement that progressed in size over the last 7 years of follow-up with her haematologist with evidence of haematological parameters consistent with CLL. She reported waking up unrefreshed from 7 to 8 hours of...