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Severe Sleep Apnea Syndrome Associated with Chronic Cough Without Daytime Sleepiness
PDPI Lampung & Bengkulu, 12 Okt 2018 13:17:02


Common causes for chronic cough include gastroesophageal reflux disease , cough-variant asthma, and upper airway cough syndrome . Despite following the recommendations of current guideline for diagnosis and treatment, a significant proportion of chronic cough patients fail to resolve their cough. Recent studies indicate that the treatment of concomitant obstructive sleep apnea syndrome (OSAS) may help with cough resolution. We investigated the prevalence of OSAS, cough severities, and the effect of continuous positive airway pressure (CPAP) therapy in patients with difficult chronic cough without daytime sleepiness. We investigated 4 difficult chronic cough patients who were intractable for treatment according to current guidelines. Clinical data, treatments provided, cough duration, cough severity (visual analogue scale: VAS), Epworth sleepiness scale (ESS), and apnea hypopnea index (AHI) were evaluated. All patients did not exhibit daytime sleepiness, according to ESS score (ESS: 2-3), but eventually they were diagnosed with severe OSAS (AHI: 42-90). Cough duration was 5 months to 10 years. Cough severities were moderate to severe . The cough of all patients improved after CPAP therapy. There was no relationship between severity of cough and cough duration, BMI, or AHI (cough duration r=0.5, p=0.5; BMI r=-0.21, p=0.79; AHI r=-0.21, p=0.78). These results suggest that examination for OSAS in the case of difficult chronic cough should be considered even without daytime sleepiness. The symptom of daytime sleepiness may be masked by the severity of the cough. Further studies are required to examine the mechanisms underlying OSAS that induce chronic cough and the effect of CPAP in such cases.

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