A 77-year-old man with severe obstructive sleep apnea (OSA) developed classic exploding head syndrome (EHS), with sudden nocturnal “explosions” at sleep onset. He initially used a mandibular advancement device, which only partially controlled respiratory events. After starting continuous positive airway pressure with excellent adherence and with a residual Apnea-Hypopnea Index score below 5 events per hour, EHS episodes decreased from frequent, debilitating events to about once monthly, alongside improved sleep continuity and daytime alertness. This case suggests that OSA may be a modifiable contributor to EHS and supports routine evaluation for sleep-disordered breathing in patients with this underrecognized parasomnia.
Behrouz Jafari (Mon,) studied this question.