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[Hemoptysis due to severe obstructive sleep apnea].

Mohamed Garhy1, Charlotte Eggers1, Chiraz Chwich1

  • 1Klinik für Innere Medizin, Pneumologie und Intensivmedizin, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum Ostwestfalen Lippe (OWL) der Universität Bielefeld, Bielefeld, Deutschland.

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Severe obstructive sleep apnea (OSA) can cause hemoptysis (coughing up blood) due to extreme negative intrathoracic pressures from airway obstruction. This case highlights OSA as an underrecognized cause of bleeding in the airways.

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Area of Science:

  • Medicine
  • Pulmonology
  • Sleep Medicine

Background:

  • Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent upper airway collapse during sleep.
  • Hemoptysis is typically associated with conditions like bronchitis, tuberculosis, or lung cancer.
  • The link between OSA and hemoptysis is not well-established in medical literature.

Purpose of the Study:

  • To report a case of chronic hemoptysis caused by severe obstructive sleep apnea.
  • To highlight the role of intrathoracic negative pressures in OSA-induced airway bleeding.
  • To emphasize OSA as a differential diagnosis for hemoptysis.

Main Methods:

  • Case report of a patient with chronic hemoptysis and symptoms of OSA.
  • Clinical evaluation including bronchoscopy under sedation, revealing hypopharyngeal collapse and airway bleeding.
  • Polysomnography with transcutaneous CO2 monitoring to diagnose OSA severity and associated hypoventilation.

Main Results:

  • The patient presented with chronic mild hemoptysis, daytime sleepiness, and a history of smoking.
  • Bronchoscopy revealed mucosal bleeding during induced airway collapse and negative pressure.
  • Polysomnography confirmed severe OSA (AHI 76/h) with hypoventilation (PCO2 56 mmHg).

Conclusions:

  • Severe OSA can lead to significant intrathoracic negative pressures, causing airway mucosal bleeding and hemoptysis.
  • OSA should be considered in the differential diagnosis of patients presenting with hemoptysis, especially those with risk factors like obesity and smoking.
  • Effective treatment of OSA with positive airway pressure can resolve associated hemoptysis.