Resistant hypertension and Morgagni hernia: The importance of nocturnal hypoxaemia

Abstract

A 51-year-old woman consulted for resistant arterial hypertension despite adequate antihypertensive treatment. Physical examination and analytical study showed no relevant abnormalities, with pulse oximeter saturation of 95%. The study highlighted nocturnal respiratory polygraphy with data of mild intensity sleep apnoea syndrome, and severe nocturnal hypoxaemia (apnoea hypopnoea index per hours of sleep [AHI] 7.8; desaturation index per hour [ODI]: 12.6. Oxygen-medium saturation: 89%, minimum saturation: 72%. CT90: 34.2%). The chest X-ray showed elevation of the right hemidiaphragm, and the chest computed tomography (CT) revealed a Morgagni hernia with a maximum diameter of 20cm. After adjusting the antihypertensive treatment, the patient was referred to General Surgery for intervention. The onset of resistant hypertension secondary to severe nocturnal hypoxemia from a large Morgagni hernia has not been previously described in the literature.

Keywords: Hernia de Morgagni; Hipertensión; Hipertensión resistente; Hipoxemia nocturna; Hypertension; Morgagni's hernia; Nocturnal hypoxemia; Resistant hypertension; Sleep apnoea–hypopnoea syndrome; Síndrome de apnea hipopnea nocturna.