Sleep apnea syndrome after total laryngectomy

Introduction Tracheostomy was the treatment of choice for sleep apnoea syndrome before nasal continuous positive airway pressure was developed. The occurrence of sleep apnea syndrome after total laryngectomy is unusual. Case report The authors report the case of a 73 year-old man presenting with the symptomatology of sleep apnoea syndrome, several years after a total laryngectomy for cancer. The polysomnographic recording confirmed severe sleep apnoea syndrome with an apnea-hypopnea index of 89. Clinical examination showed a marked reduction in the diameter of the tracheostomy orifice during forced inspiration whilst lying supine. The combination of negative airway pressure and muscle hypotonia during sleep could explain this closure. Use of a silver tracheostomy cannula reversed the symptoms and normalised the apnea-hypopnea index. Conclusion Sleep apnea syndrome is an unusual complication of total laryngectomy, resulting from collapse of the tracheostomy walls during sleep, which can be treated by the insertion of a silver tracheostomy tube.