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Case report
peer-reviewed

Obstructive Sleep Apnea Presenting as Non-epileptic Spells: A Unique Combination



Abstract

Obstructive sleep apnea (OSA), an increasingly prevalent sleep disorder, has been extensively studied in both clinical and scientific settings. In most cases, the diagnosis of sleep apnea is straightforward with patients having symptoms of snoring, choking or gasping for air while asleep and witnessed apneas. However, sleep apnea is known to present in some unusual ways. We present a case of a 61-year-old male, with recently diagnosed obstructive sleep apnea (currently not on continuous positive airway pressure (CPAP)) and a history of seizure-like events since the age of 18 years, who came to the epilepsy monitoring unit (EMU) for spell characterization of his frequent seizure-like episodes. A continuous video electroencephalogram (vEEG) performed in order to determine the semiology of these spells showed that all the spells were triggered by an arousal from sleep with an associated apneic event. He was started on positive airway pressure (PAP) therapy, which resulted in the gradual decline in the number as well as the severity of his seizure-like spells. Based on the observations from vEEG monitoring and the patient’s response, we concluded these seizure-like events as non-epileptic spells, triggered by apnea-related arousals in the context of OSA.



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Case report
peer-reviewed

Obstructive Sleep Apnea Presenting as Non-epileptic Spells: A Unique Combination


Author Information

Prashant Natteru

Department of Neurology, University of Mississippi Medical Center

Chintan Rupareliya Corresponding Author

Department of Neurology, University of Missouri, Columbia, Missouri

Xiangping Zhou

Neurology, University of Missouri Healthcare

Pradeep C Bollu

Neurology, University of Missouri


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Obstructive Sleep Apnea Presenting as Non-epileptic Spells: A Unique Combination


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Case report
peer-reviewed

Obstructive Sleep Apnea Presenting as Non-epileptic Spells: A Unique Combination

Prashant Natteru">Prashant Natteru, Chintan Rupareliya">Chintan Rupareliya , Xiangping Zhou">Xiangping Zhou, Pradeep C Bollu">Pradeep C Bollu

  • Author Information
    Prashant Natteru

    Department of Neurology, University of Mississippi Medical Center

    Chintan Rupareliya Corresponding Author

    Department of Neurology, University of Missouri, Columbia, Missouri

    Xiangping Zhou

    Neurology, University of Missouri Healthcare

    Pradeep C Bollu

    Neurology, University of Missouri


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: October 24, 2017

    DOI

    10.7759/cureus.1800

    Cite this article as:

    Natteru P, Rupareliya C, Zhou X, et al. (October 24, 2017) Obstructive Sleep Apnea Presenting as Non-epileptic Spells: A Unique Combination. Cureus 9(10): e1800. doi:10.7759/cureus.1800

    Publication history

    Received by Cureus: October 16, 2017
    Peer review began: October 20, 2017
    Peer review concluded: October 24, 2017
    Published: October 24, 2017

    Copyright

    © Copyright 2017
    Natteru et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Obstructive sleep apnea (OSA), an increasingly prevalent sleep disorder, has been extensively studied in both clinical and scientific settings. In most cases, the diagnosis of sleep apnea is straightforward with patients having symptoms of snoring, choking or gasping for air while asleep and witnessed apneas. However, sleep apnea is known to present in some unusual ways. We present a case of a 61-year-old male, with recently diagnosed obstructive sleep apnea (currently not on continuous positive airway pressure (CPAP)) and a history of seizure-like events since the age of 18 years, who came to the epilepsy monitoring unit (EMU) for spell characterization of his frequent seizure-like episodes. A continuous video electroencephalogram (vEEG) performed in order to determine the semiology of these spells showed that all the spells were triggered by an arousal from sleep with an associated apneic event. He was started on positive airway pressure (PAP) therapy, which resulted in the gradual decline in the number as well as the severity of his seizure-like spells. Based on the observations from vEEG monitoring and the patient’s response, we concluded these seizure-like events as non-epileptic spells, triggered by apnea-related arousals in the context of OSA.



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Prashant Natteru, Resident Physician

Department of Neurology, University of Mississippi Medical Center

Chintan Rupareliya

Department of Neurology, University of Missouri, Columbia, Missouri

For correspondence:
drchintan2000@hotmail.com

Xiangping Zhou, M.D., Ph.D.

Neurology, University of Missouri Healthcare

Pradeep C Bollu, M.D., Assistant Professor

Neurology, University of Missouri

Prashant Natteru, Resident Physician

Department of Neurology, University of Mississippi Medical Center

Chintan Rupareliya

Department of Neurology, University of Missouri, Columbia, Missouri

For correspondence:
drchintan2000@hotmail.com

Xiangping Zhou, M.D., Ph.D.

Neurology, University of Missouri Healthcare

Pradeep C Bollu, M.D., Assistant Professor

Neurology, University of Missouri