Breathless Laughter: Tackling Tussive Syncope in the Shadows of Obstructive Sleep Apnea

Cough is a common complaint in the inpatient and outpatient setting. Most cases are caused by upper airway syndrome, gastroesophageal reflux disease, asthma, bronchitis, or infections. Complications that can be life-threatening include syncope and arrhythmias. Our case is of a 67-year-old obese male who had a chronic cough that led to syncope. The chronic cough was present for months, non-responsive to symptomatic treatment, and negative on outpatient work up with no clear common causes leading to hospitalization. After extensive imaging and cardiopulmonary work up yielding normal results, his underlying obstructive sleep apnea and therapy noncompliance was a likely cause. After symptomatic treatment and positive pressure therapy compliance, his cough improved, and syncope resolved. Obstructive sleep apnea, commonly seen in obese individuals, may be a contributor to tussive syncope that has not been described in the literature, which healthcare providers should be aware of.