Chronic lymphatic leukaemia presenting as severe obstructive sleep apnoea

A case of adenotonsillar enlargement from chronic lymphatic leukaemia leading to severe obstructive sleep apnoea (OSA) is described. Nasal continuous positive airway pressure (nCPAP) therapy was poorly tolerated because even at high pressures (+15 cm H2O) obstructive hypopnoeas persisted. Tonsillectomy resulted in significant improvement, though OSA persisted. nCPAP was reintroduced and at low pressures (+6 cm H2O) was efficacious in alleviating the patient's symptoms. This report highlights the need to consider OSA as a cause of constitutional symptoms in adults with lymphoreticular disease, especially where there is involvement of Waldeyer's ring.