Sleep-related laryngospasm (1)

A healthy 65-year-old man, sleeping in a supine position during a diurnal nap, suddenly awakens from sleep with a cough followed by increased inspiratory efforts, severe air hunger, and inspiratory stridor. The patient becomes extremely frightened, repeatedly calling out “doctor, doctor” because he was unable to catch his breath. The episodes last a few seconds. The polysomnographic tracing shows only a slight SaO2 decrease to 92%. The patient had never been diagnosed with gastroesophageal reflux disease (GERD), but his symptoms were clearly indicative of reflux disease. On physical examination, he had classical laryngeal findings of reflux (inflamed post-cricoid area with hypertrophic arytenoid mucosa). (Contributed by Dr. Federica Provini.)