1227 Spinal Stenosis as a Rare Cause of Central Sleep Apnea

Abstract Introduction Central sleep apnea is characterized by lack of drive to breathe during sleep, resulting in periods of insufficient ventilation and compromised gas exchange. CSA causes based on the awake Paco2 either hypercapnic and a nonhypercapnic group. Common causes include high-altitude, congestive heart failure, and chronic use of opioids and its very rare to be secondary to spinal stenosis. Report of case(s) 49 years old male patient known to have hypertension and cervical spondylosis causing severe canal stenosis on epidural steroid injection. He was Referred to sleep medicine clinic for the assessment of possible obstructive sleep apnea, as he has interrupted sleep, history of snoring and witnessed apnea. Calculated STOP BANG 6. on examination, BMI 33, neck circumference 44 cm, micrognathia and malapati class 4, Split night sleep study showed severe respiratory events with AHI of 125.4 mainly central apneas with total 177 episodes, Frequent arousals related to events and oxygen desaturation were recorded to 82%. End tidal CO2 reached 57 mmhg during the study. CPAP titration was initiated and pressure gradually increased and ended at 12.0 cmH2O where all respiratory events were controlled with REM sleep supine position. Day time arterial blood gas showed PH 7.437 PaCo2 39mmhg, PaO2 86.9 mmhg and Hco3 26.2 mmol/ liter with base excess +2.1. Investigation for the cause of central sleep apnea were negative except for cervical MRI which showed multilevel degenerative disc disease at the level of C3-C4 ,C4-5, C5-6 and C6-7 causing different severity of neural foramen stenosis and nerve root compression. Based on the investigations the patient was diagnosed with severe central sleep apnea secondary to severe spinal stenosis, he was started on CPAP 12 cmh2o well tolerated and complaint to the PAP and his latest CPAP data showed AHI of 8/hour. For the spinal stenosis he is following with spine surgery and pain management team for pain control. Conclusion To diagnose the cause of central sleep apnea it is mandatory to exclude all other possible causes and consider spinal stenosis when facing a case with isolated central sleep apnea. Support (if any)