Reversible obstructive sleep apnea caused by occupational exposure to guar gum dust

This report describes a case of reversible obstructive sleep apnea caused by occupational exposure to an inhaled allergen, guar gum powder. The patient, a pet food plant employee, also experienced severe cough, rhinitis, and conjunctivitis. Skin tests confirmed the specific guar allergy. Pharyngeal cross-sectional area was smaller than normal. Pulmonary function studies, histamine challenge tests, nasal air-flow resistance measurements, and nocturnal polysomnography were performed on 3 separate occasions: while the patient was working at his usual occupation, at the end of a 3-wk holiday, and after a guar dust challenge in an inhalation chamber. Pulmonary function and histamine challenge tests were consistently normal. At the time of the initial tests, nasal resistance was elevated, and nocturnal polysomnography revealed obstructive sleep apnea. After absence from work, obstructive sleep apnea resolved, and the nasal resistance returned to normal. After challenge with guar gum dust, the patient developed increased resistance to nasal air flow, and obstructive sleep apnea reappeared. This case demonstrates that allergy can cause reversible obstructive sleep apnea and that occupational exposure should be considered in the assessment of patients with this disease.