1192 A Case of Worsening Exploding Head Syndrome When Using Positive Airway Pressure

Abstract Introduction Exploding head syndrome (EHS) is a rare parasomnia with unclear etiology. There are limited research studies to confirm the exact predisposing and precipitating factors for its onset and frequency. Some published case reports suggest symptomatic improvement with the treatment of comorbid obstructive sleep apnea (OSA). This case presents a patient who received automatic positive airway pressure (APAP) treatment for OSA with worsening EHS symptoms. Report of case(s) A 41-year-old male with obesity (BMI of 33) and chronic back pain complained of visual and audio sensations of explosion, vibration, and light when falling asleep and waking up in the middle of the night without any associated physical pain. These events would occur twice a month and were accompanied by waking up three to four times nightly due to loud snoring. A home sleep study (HSAT) was completed and consistent with mild obstructive sleep apnea, demonstrating a respiratory event index (REI) of 7.4 events per hour. The patient was diagnosed with exploding head syndrome and OSA. He was started on APAP therapy. At the six-week follow-up, he noted worsening frequency of EHS events to twice a week. During this time, he lost his job. At the three-month follow-up since starting APAP, he reported further worsening of his EHS episodes to three times a week. The patient was not compliant with APAP usage. The compliance data revealed average usage of 2-3 hours a night with residual AHI of 1.2/hour. Conclusion EHS is a rare disorder with unknown predisposing and precipitating factors. This patient noted worsening of his EHS after the initiation of APAP therapy for his obstructive sleep apnea. However, the patient was not fully compliant with PAP therapy. He also underwent further stressors during this period. This case raises consideration regarding the side effects of APAP therapy on the severity of EHS when treating OSA. Support (if any)