0849 Baclofen-induced severe central sleep apnea

Abstract

Abstract Introduction Baclofen is a gamma-aminobutyric acid-B agonist that targets neurons in the spinal cord and brain. It has skeletal muscle-relaxant properties and is FDA approved to treat spasticity from spinal cord injury (SCI), multiple sclerosis, or traumatic brain injury. Off label use includes treatment of alcohol use disorder, hiccups, and muscle spasms. A rare respiratory side effect of baclofen is apnea, with reports of baclofen-induced central sleep apnea (CSA) in a pediatric patient and four adults with alcohol use disorder. We describe a case of severe CSA in a veteran with T7 paraplegia due to chronic baclofen use. Report of Cases: A 42-year-old veteran with T7 paraplegia was referred to sleep medicine for unrefreshing sleep. He had a remote history of spinal cord injury complicated by spasticity that was being treated with oral baclofen (40 mg TID). Further evaluation of unrefreshing sleep was obtained with baseline polysomnography. A total of 146 apnea and hypopnea events were observed (5 obstructive apneas, 131 central apneas, 4 mixed apneas and 6 hypopneas) for an AHI of 43.2 events/hour. Minimum oxygen saturation was 85% with 0.3 minutes spent <89%. Respiratory pattern was suggestive of crescendo decrescendo breathing but did not meet diagnostic criteria for Cheyne-Stokes respiration (cycle length <40 seconds). Other causes of CSA were investigated but unrevealing. A diagnosis of baclofen-induced central sleep apnea was made. Conclusion Spasticity is a common consequence of SCI and is commonly managed with baclofen. Apnea is a rare respiratory side effect of baclofen but can significantly impact patients’ sleep quality and overall quality of life. Our case highlights how providers should have a high suspicion for sleep-disordered breathing in patients with chronic baclofen use. Support (If Any) 1. Ghanavatian S, Derian A. Baclofen. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 15, 2021.2. Locatelli F, Formica F, Galbiati S, et al. Polysomnographic Analysis of a Pediatric Case of Baclofen-Induced Central Sleep Apnea. J Clin Sleep Med. 2019;15(2):351-354. Published 2019 Feb 15. doi:10.5664/jcsm.76443. Olivier PY, Joyeux-Faure M, Gentina T, et al. Severe Central Sleep Apnea Associated With Chronic Baclofen Therapy: A Case Series. Chest. 2016;149(5):e127-e131. doi:10.1016/j.chest.2015.10.001