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Sleep Surgeon Question 22

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Question 22 - Throat closing after surgery.

From: M. W.

Surgery doc:

Please help! My wife had ovarian cyst surgery on September 1st, 2006. The surgery was for a partial cystectomy and to remove some adhesions from a previous surgery. Since then she has experienced what she describes as her “throat closing” at night. She awakens in a rush of adrenaline that she says feels like an electric shock. She has a lot of trouble returning to sleep after this. Her “throat closes” most nights but not all (at least she is not awakened by it.) Immediately following surgery she experienced spikes in her blood pressure that persisted for hours and pain in her chest. Her blood pressure is characteristically low in the area of the 90’s over 60’s range. She was admitted to the hospital about 1-2 weeks post surgery. They ran a battery of tests and blood work. She was seen by a Pulminologist who suspected post surgery lung clots and had a lung scan that showed that she didn’t have any clots but has nodules in her lungs (which have not changed after several subsequent checks). She saw a cardiologist who diagnosed mitral valve prolapse which he described as a benign condition with relatively negligible effects. He attributed the pain in the chest to the mitral valve prolapse. She saw an ENT 2 months after the surgery who prescribed Protonix for inflammation due to esophygeal reflux. She’s been on that ever since and has seen another ENT who says everything looks fine but that she has a deviated septum that may be causing the throat closing issue. She has seen a sleep specialist who feels that she doesn’t have a weak palette. She is a fit, non-smoking, 105 lb. 35 year old woman who doesn’t seem to fit in with any of the typical apnea patients. Her blood pressure is again back to its low (normal) readings. She has had a sleep study (unfortunately on a night where the throat closing didn’t occur.) so it was not conclusive enough for anyone to order a C-pap. Her hormone levels are normal. She has no symptoms during the day except extreme fatigue. She had a brain MRI to see if there was anything that may be causing small seizures. Nothing medically significant found all was normal. She experiences this “throat closing” even out of town so we suspect that it is nothing environmental in the house.

This whole thing began immediately after surgery. We suspect that there might be some latent minor nerve damage, but no one can confirm it. Our most recent idea is that it may be idiopathic central sleep apnea. It’s so frustrating that there is no diagnosis or treatment plan available.

This throat closing problem isn’t going away. It is a mystery to all of the medical professionals we’ve seen. It is completely ruining our and our children’s quality of life. We need some help. Please give us any information that could be beneficial.

Thank you.

Answer Provided by Dr. Kasey Li
Sept 23, 2007

Waking up having sensation of “throat closing” seems more like obstructive airway problems and not “central sleep apnea”. I would suggest obtaining another sleep study. Possibly a trial of CPAP to see if it helps.

Good luck.

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