Abstract Introduction Positive airway pressure (PAP) therapy is the first-line treatment for obstructive sleep apnea (OSA; Veasey & Rosen, 2019). Although this treatment is effective, rare and often underreported complications, such as pneumothorax, have been documented—particularly with high-pressure noninvasive ventilation (Rajdev et al., 2020). Treatment of OSA can be further complicated by the presence of comorbidities such as atrial fibrillation (Linz et al., 2021). Report of case(s) We report the case of a 67-year-old male with a history of hypertension, dyslipidemia, atrial fibrillation in remission (status post ablation), and previously diagnosed moderate OSA on CPAP therapy who experienced a severe right-sided pneumothorax after being switched to adaptive servo-ventilation (ASV) following the diagnosis of atrial fibrillation. Conclusion Sleep apnea severity and phenotype can change over time as new health conditions emerge. This case highlights the importance of vigilant and routine monitoring. Careful follow-up and reassessment of PAP modality and pressure can minimize the risk of pneumothorax, a potentially life-threatening complication. This case further demonstrates the need for ongoing evaluation by an expert clinician, particularly for high-risk patients treated with high-pressure PAP using advanced modalities. Support (if any) 1.Veasey, S. C., & Rosen, I. M. (2019). Obstructive sleep apnea in adults. The New England Journal of Medicine, 380(15), 1442–1449. https://doi.org/10.1056/NEJMcp1816152 2. Rajdev, K., Idiculla, P. S., Sharma, S., Von Essen, S. G., Murphy, P. J., & Bista, S. (2020). Recurrent pneumothorax with CPAP therapy for obstructive sleep apnea. Case Reports in Pulmonology, 2020, Article 8898621. https://doi.org/10.1155/2020/8898621 3. Linz, D., Nattel, S., Kalman, J. M., & Sanders, P. (2021). Sleep apnea and atrial fibrillation. Cardiac Electrophysiology Clinics, 13(1), 87–94. https://doi.org/10.1016/j.ccep.2020.10.003
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