Abstract
Obstructive sleep apnea hypopnea syndrome (OSAHS) and parasomnia overlap disorder (POD) are types of sleep disorders. When the symptoms of both conditions coexist, the POD symptoms are most likely caused by OSAHS. In these cases, the symptoms of POD will be relieved when OSAHS is effectively treated. We refer to these cases as symptomatic POD (related to OSAHS), which differs in pathophysiology, complications, and treatment from idiopathic POD. It is important to note that the treatment for idiopathic POD may aggravate the symptoms of OSAHS. In this case, we used video polysomnography (v-PSG) on a POD patient with suspected OSAHS to distinguish idiopathic POD from symptomatic POD, to inform the appropriate treatment course. The video results and clinical features lead us to diagnose symptomatic POD, and we treated the patient with auto-set continuous positive airway pressure to address their OSAHS. This course of treatment resolved all POD-related symptoms. Here, we discuss this case and review the relevant literature. This report highlights the importance of the use of v-PSG in the clinical diagnosis, differential diagnosis, and subsequent treatment of POD.
Highlights
Obstructive sleep apnea hypopnea syndrome (OSAHS) is a seriously underestimated chronic disease
Features supporting an epileptic etiology of paroxysmal events are (Salman et al, 2020) stereotyped nature of the spells; (Jehan et al, 2018) high frequency and tendency to cluster; and (Kapur et al, 2017) timing of the events (NREM parasomnias usually emerge from slow-wave sleep, which typically occurs within 2 h of sleep onset, whereas frontal lobe seizures may occur during any sleep stage but are common shortly after falling asleep)
The patient we reported in this article is an OSAHS patient with nightmares as the main complaint accompanied by Parasomnia overlap disorder (POD) symptoms (RBD and night terror)
Summary
Obstructive sleep apnea hypopnea syndrome (OSAHS) is a seriously underestimated chronic disease. A 46-year-old male patient (weight 71.5 kg; height 169 cm; body mass index 25.03 kg/m2; neck circumference 45 cm; modified Mallampati score 3) was referred to our sleep center with a 6year history of vivid, disturbed dreams and 3-month history of repeated nocturnal episodes of violent and complex behaviors, clearly reflecting dream enactment with frequent dream recall. In these 3 months, due to the increased workload, he was under tremendous stress. The complete eradication of POD symptoms following APAP treatment further confirmed our diagnoses of symptomatic POD, as had it been idiopathic POD, the treatment would have exacerbated or have not improved his symptoms of POD
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