Obstructive sleep apnea-hypopnea syndrome induced by dexmedetomidine in a patient with long-term sedatives: A case report

Rationale: Dexmedetomidine is extensively recognized as a sedative featuring a relatively mild respiratory depressant effect. Nevertheless, for patients who are on long-term sedative use and potentially suffer from co-morbid insomnia and sleep apnea (COMISA), the safety of this drug remains ambiguous. This case report uncovers a rare yet severe adverse reaction associated with this drug. Patient concerns: A 62-year-old male with a 2-year history of insomnia has been on long-term use of multiple sedative agents. He reported persistent symptoms including poor sleep quality, daytime fatigue, and cognitive decline, along with a strong desire to reduce his medication burden. Diagnoses: During the patient’s hospitalization, polysomnography results confirmed that the patient suffered from severe obstructive sleep apnea-hypopnea syndrome (OSAHS). This condition was induced by the administration of dexmedetomidine during the infusion process. Interventions: Before conducting the sleep monitoring, CBTI (cognitive behavioral therapy for insomnia), stellate ganglion block, ozone enema, and traditional Chinese medicine treatment were performed. After the diagnosis of severe OSAHS was confirmed, dexmedetomidine was immediately discontinued. Subsequently, noninvasive ventilation was adopted as the main auxiliary treatment method. Outcomes: After the intervention measures were implemented, the patient’s sleep quality and oxygen supply condition significantly improved. During the follow-up, he successfully reduced his reliance on sedative-hypnotic drugs. Lessons: This case indicates that for patients with a long history of using sedatives, dexmedetomidine may cause or exacerbate severe OSAHS. Clinicians should be vigilant and consider conducting sleep apnea screening for high-risk patients before using sedatives and be prepared with noninvasive ventilation support equipment.