1355 Sodium Oxybate-Associated Central Sleep Apnea in Idiopathic Hypersomnia

Abstract Introduction It is estimated that as many as 50% of patients with Idiopathic Hypersomnia (IH) have Obstructive Sleep Apnea (OSA). Treatment of IH and OSA becomes complex due to overlapping symptoms. We present a case of a patient with a history of OSA and IH who developed treatment-emergent Central Sleep Apnea (CSA) after initiation of low-sodium oxybate therapy while on PAP therapy. Report of case(s) A 37-year-old female with a history of IH and OSA presented for evaluation of persistent hypersomnia despite adherent CPAP use, low-sodium oxybate, and stimulant therapy. The patient was diagnosed with IH in adolescence, and hypersomnia was well-controlled with stimulant therapy. Years later, after significant weight gain, OSA was diagnosed and treated with auto-adjusting CPAP. She experienced a gradual worsening of hypersomnolence despite control of OSA on CPAP and was trialed on other stimulants, which were ineffective. The patient was subsequently started on low-sodium oxybate therapy, which moderately improved hypersomnia symptoms. After initiation of therapy, PAP-generated AHI was noted to be elevated with predominantly central apneas, which was not present on prior sleep studies or PAP reports. She completed 2 separate unsuccessful titration studies in which CPAP, BPAP, and BPAP-ST were ineffective at controlling central events. Patient is planned for ASV titration and possible reduction in low-sodium oxybate dose. Conclusion The ongoing hypersomnia and central sleep apneas may be associated with sodium oxybate and/or CPAP therapy. This poses a challenge to management as a reduction in the dose of sodium oxybate might worsen hypersomnia. Our case emphasizes the importance of evaluating the complex treatment needs of patients with IH and coexisting OSA who develop treatment-emergent central sleep apnea and persistent hypersomnia while using low-sodium oxybate and PAP therapy. Support (if any)