0807 Sleep-related hiccups: A case report of antidepressant associated hypnic jerks

Abstract

Abstract Introduction A hiccup is a sudden activation of inspiratory muscles, followed by paradoxical glottic closure, producing a familiar sound [1]. Antidepressants are commonly prescribed and hypnic jerks and hiccups have been reported as a rare adverse drug reaction [2]. Few reports have described pronounced hypnic hiccups with subsequent audio/video polysomnogram confirmation. Report of Cases: A 44-year old man with a history of depression, anxiety, and alcohol use disorder presented to clinic with a long history of violent hypnic jerks associated with a loud hiccup. These episodes started 30 minutes before he fell asleep and continued throughout the night every 30 minutes with forceful hiccups that were so loud they wake others in his house. We believe that these episodes were likely induced by venlafaxine since they were noted initially 8 years ago when he started taking venlafaxine and there was complete remission after discontinuation of the medication. He was later prescribed escitalopram 20 mg daily, restarted on venlafaxine XR 150 mg daily, and later sertraline 100 mg daily due to refractory depression and anxiety recurrence. Episodes progressively became more frequent and pronounced that he avoided sleep and they impacted his ability to hold a relationship. Gabapentin and clonazepam did not previously improve symptoms. He took trazodone 50 mg every other night to aid falling asleep and reported to have less frequent hypnic jerks. Upon presentation to our clinic, subsequent PSG demonstrated severe obstructive sleep apnea (AHI 63, HI 52, CI 11) with significant sleep fragmentation (sleep efficiency 46%) with very frequent sudden axial myoclonic contractions with head and neck movements along with vocalizations likely representing hiccups. Video and audio demonstrated the loud hiccups described. These events occurred while the patient was resting awake and transitioning to sleep and was less frequent but persisted in N2. The patient was prescribed CPAP for sleep apnea and recommended to follow up with psychiatry to consider other medications. Conclusion Pronounced hypnic jerks and sleep-related hiccups can significantly impact total sleep time, sleep quality, and quality of life. Clinicians should be aware of these potential side effects in patients on antidepressants. Support (If Any) 1. Askenasy JJ. About the mechanism of hiccup. Eur Neurol. 1992;32:159-63.2. Bagheri H, Cismondo S, Montastruc JL. Hoquet d'origine médicamenteuse: enquête à partir de la Banque Nationale de Pharmacovigilance [Drug-induced hiccup: a review of the France pharmacologic vigilance database]. Therapie. 1999 Jan-Feb;54(1):35-9. French. PMID: 10216420.