843 Paradoxical Waking Hypoxemia that Improves with Sleep

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A328-A328
Author(s):  
Jessica Cho ◽  
David Dai ◽  
Constance Fung
Keyword(s):  
Pulmonary Hypertension ◽  
Case Reports ◽  
Supplemental Oxygen ◽  
Nocturnal Hypoxemia ◽  
Cpap Titration ◽  
Obstructive Sleep ◽  
Paradoxical Worsening ◽  
Chronic Hypoxemia ◽  
Function Testing ◽  
Titration Study

Abstract Introduction We present a case of paradoxically worsened hypoxia during wake phase of polysomnography while undergoing a CPAP titration study. Nighttime hypoxemia is a common feature in obstructive sleep apnea, due to obstructive events that manifest while sleeping. Excluding OSA, there remains an extensive differential for disease processes that cause hypoxemia while asleep; however, none of these processes can explain waking hypoxemia that improves upon sleeping. Report of case(s) A 70 year old male with severe OSA diagnosed by home sleep test (REI 46.5, nadir O2=76%) underwent polysomnography with PAP titration and demonstrated several hours of interrupted sleep without hypoxia and minimal obstructive events on CPAP 9–13 cmH2O. During the study, while awake at CPAP of 14 cmH2O, he developed hypoxia to mid-high 80s and supplemental oxygen bleed in was added starting at 3L and increased to 5L during a prolonged period of wakefulness. On CPAP 15 cmmH2O with 5L bleed-in, the patient fell asleep and oxygen saturation again increased to low 90s. He underwent an extensive workup for other cardiopulmonary causes of hypoxemia, with pulmonary function testing showing moderate obstructive ventilatory defect and mild DLCO impairment. An echocardiogram with saline contrast bubble study was relatively unremarkable, without evidence of right to left shunting. He underwent a chest CTA which was negative for pulmonary embolism, though it did reveal an enlarged pulmonary artery consistent with pulmonary hypertension. His chronic hypoxemia was treated with 2L supplemental oxygen during the day and bleed-in with CPAP at night. Conclusion Though nocturnal hypoxemia is common with OSA, polysomnography with paradoxical hypoxemia during wake phase has not been reported. Notably, the patient was without prolonged hypoxia during his sleep phase while on CPAP treatment with minimal apneic/hypopneic events. Pulmonary hypertension can also present as nocturnal hypoxemia, but it should worsen with sleep, rather than improve. There are case reports of right to left shunting worsened by PAP, though his hypoxemia persisted despite PAP. His paradoxical worsening hypoxemia with wakefulness is still unexplained. Support (if any):

scholarly journals 1242 An Adult with ROHHAD Disease

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A473-A474
Author(s):  
Hamna Ahmad ◽  
Ashraf Gohar
Keyword(s):  
Early Childhood ◽  
Behavioral Problems ◽  
Case Reports ◽  
Genetic Disorders ◽  
Rapid Onset ◽  
Maximum Pressure ◽  
Cpap Titration ◽  
Central Hypoventilation ◽  
Central Apneas ◽  
Titration Study

Abstract Introduction Rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation (ROHHAD) is an extremely rare and fatal disease presenting in early childhood. Report of Case A 25-year-old male, seen in our adult sleep clinic to establish care at the age of 21. He was previously followed by pediatric sleep department. He was diagnosed with ROHHAD syndrome in early childhood after presenting at the age of 18 months. At the time, he was diagnosed with central hypoventilation with multiple endocrinopathies. He was noted to have mild mental retardation and behavioral problems. He was initially worked up for multiple genetic disorders and was eventually diagnosed with ROHHAD syndrome. As a pediatric patient, he had a CPAP titration study that was unsuccessful with persistent central apneas. Eventually, he was treated with auto-SV (with minimum and maximum pressure support of 1 and +15 respectively, an EPAP max of +20, and EPAP min of +5). He has since been doing well with ASV. He also had insomnia and hypersomnia and is being treated with Modafinil for excessive daytime sleepiness and Zolpidem for the insomnia. Conclusion The mortality related to cardiorespiratory arrest in ROHHAD disease has been estimated to be 40-50%. To our knowledge, case reports of adult patients with ROHHAD in literature, are few and far between.

scholarly journals Comparing Pressures Required to Abolish Snoring and Sleep Apnea

2001 ◽  
Vol 8 (6) ◽  
pp. 427-430 ◽  
Author(s):  
V Hoffstein ◽  
Z Oliver
Keyword(s):  
Sleep Apnea ◽  
Response To Treatment ◽  
Maximum Pressure ◽  
Similar Response ◽  
Tertiary Referral Centre ◽  
Cross Sectional ◽  
Cpap Titration ◽  
Obstructive Sleep ◽  
Titration Protocol ◽  
Titration Study

OBJECTIVE: Snoring and obstructive sleep apnea share similar pathogenesis and similar response to treatment with continuous positive airway pressure (CPAP). The purpose of this study was to compare pressures required to abolish apneas (POSA) with pressures required to abolish snoring (PSNOR).DESIGN: Cross-sectional, nonrandomized cohort study.SETTING: Sleep disorders clinic at St Michael's Hospital - a tertiary referral centre and a teaching hospital of the University of Toronto, Toronto, Ontario.POPULATION STUDIED: Unselected consecutive 441 patients with confirmed sleep apnea who were undergoing a CPAP titration study in the sleep laboratory.INTERVENTIONS: Nocturnal polysomnography using CPAP titration protocol, which required incremental increases in pressure until snoring and apnea were abolished or a maximum pressure of 16 cm H2O was attained. PSNORand POSAwere recorded and compared.RESULTS: Mean (± SD) pressures required to abolish snoring and apnea were: PSNOR8.3±2.57 cm H2O and POSA7.9±2.72 cm H2O (P<0.0001). In 75% of patients, the PSNORwas within ±1 cm H2O of the POSA; in 92%, it was within ±2 cm H2O; and in 97%, it was within ±3 cm H2O.CONCLUSIONS: Empirically increasing pressure by 2 cm H2O in patients on CPAP who continue to snore may abolish snoring and apnea without the necessity of another titration study.

scholarly journals Nocturnal Hypoxemia Rather Than Obstructive Sleep Apnea Is Associated With Decreased Red Blood Cell Deformability and Enhanced Hemolysis in Patients With Sickle Cell Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Emeric Stauffer ◽  
Solène Poutrel ◽  
Giovanna Cannas ◽  
Alexandra Gauthier ◽  
Romain Fort ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Pulmonary Hypertension ◽  
Sleep Apnea ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Clinical Severity ◽  
Cell Disease ◽  
Nocturnal Hypoxemia ◽  
Obstructive Sleep ◽  
Rbc Deformability

Background: Although obstructive sleep apnea (OSA) could act as a modulator of clinical severity in sickle cell disease (SCD), few studies focused on the associations between the two diseases.Research Question: The aims of this study were: (1) to explore the associations between OSA, nocturnal oxyhemoglobin saturation (SpO2) and the history of several acute/chronic complications, (2) to investigate the impact of OSA and nocturnal SpO2 on several biomarkers (hematological, blood rheological, and coagulation) in patients with SCD.Study Design and Methods: Forty-three homozygous SCD patients underwent a complete polysomnography recording followed by blood sampling.Results: The proportion of patients suffering from nocturnal hypoxemia did not differ between those with and those without OSA. No association between OSA and clinical severity was found. Nocturnal hypoxemia was associated with a higher proportion of patients with hemolytic complications (glomerulopathy, leg ulcer, priapism, or pulmonary hypertension). In addition, nocturnal hypoxemia was accompanied by a decrease in RBC deformability, enhanced hemolysis and more severe anemia.Interpretation: Nocturnal hypoxemia in SCD patients could be responsible for changes in RBC deformability resulting in enhanced hemolysis leading to the development of complications such as leg ulcers, priapism, pulmonary hypertension or glomerulopathy.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03753854.

Sleep-Disordered Breathing and Nocturnal Hypoxemia in Precapillary Pulmonary Hypertension: Prevalence, Pathophysiological Determinants, and Clinical Consequences

Respiration ◽  
2021 ◽  
pp. 1-12
Author(s):  
Jens Spiesshoefer ◽  
Simon Herkenrath ◽  
Katharina Harre ◽  
Florian Kahles ◽  
Anca Florian ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Sleep Apnea ◽  
Sleep Quality ◽  
Sleep Disordered Breathing ◽  
Central Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Amino Terminal ◽  
Nocturnal Hypoxemia ◽  
Obstructive Sleep ◽  
Disordered Breathing

<b><i>Background and objective:</i></b> The clinical relevance and interrelation of sleep-disordered breathing and nocturnal hypoxemia in patients with precapillary pulmonary hypertension (PH) is not fully understood. <b><i>Methods:</i></b> Seventy-one patients with PH (age 63 ± 15 years, 41% male) and 35 matched controls were enrolled. Patients with PH underwent clinical examination with assessment of sleep quality, daytime sleepiness, 6-minute walk distance (6MWD), overnight cardiorespiratory polygraphy, lung function, hypercapnic ventilatory response (HCVR; by rebreathing technique), amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and cardiac MRI (<i>n</i> = 34). <b><i>Results:</i></b> Prevalence of obstructive sleep apnea (OSA) was 68% in patients with PH (34% mild, apnea-hypopnea index [AHI] ≥5 to &#x3c;15/h; 34% moderate to severe, AHI ≥15/h) versus 5% in controls (<i>p</i> &#x3c; 0.01). Only 1 patient with PH showed predominant central sleep apnea (CSA). Nocturnal hypoxemia (mean oxygen saturation [SpO<sub>2</sub>] &#x3c;90%) was present in 48% of patients with PH, independent of the presence of OSA. There were no significant differences in mean nocturnal SpO<sub>2</sub>, self-reported sleep quality, 6MWD, HCVR, and lung and cardiac function between patients with moderate to severe OSA and those with mild or no OSA (all <i>p</i> &#x3e; 0.05). Right ventricular (RV) end-diastolic (<i>r</i> = −0.39; <i>p</i> = 0.03) and end-systolic (<i>r</i> = −0.36; <i>p</i> = 0.04) volumes were inversely correlated with mean nocturnal SpO<sub>2</sub> but not with measures of OSA severity or daytime clinical variables. <b><i>Conclusion:</i></b> OSA, but not CSA, is highly prevalent in patients with PH, and OSA severity is not associated with nighttime SpO<sub>2</sub>, clinical and functional status. Nocturnal hypoxemia is a frequent finding and (in contrast to OSA) relates to structural RV remodeling in PH.

847 Rapid Improvement of Pulmonary Hypertension with Adequate Ventilatory Support in Patient with Prader-Willi Syndrome

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A329-A330
Author(s):  
Erin McHugh ◽  
Megan Gubichuk ◽  
Sonal Malhotra
Keyword(s):  
Pulmonary Hypertension ◽  
Developmental Delay ◽  
Systolic Function ◽  
Ventilatory Support ◽  
Type Ii Diabetes Mellitus ◽  
Supplemental Oxygen ◽  
Apnea Hypopnea Index ◽  
Prader Willi Syndrome ◽  
Rapid Improvement ◽  
Obstructive Sleep

Abstract Introduction Prader-Willi syndrome (PWS) is a genetic multi-system disorder characterized by developmental delay, hyperphagia, and often morbid obesity. Patients can have impairments in ventilatory control and are at risk for sleep disordered breathing due to craniofacial abnormalities, obesity, hypothalamic dysfunction, hypotonia and respiratory muscle weakness. This places them at higher risk for obstructive sleep apnea (OSA), hypoventilation and, if left untreated, may lead to cardiovascular complications. We present a patient with pulmonary hypertension (PH) in the setting of PWS and under supported OSA. Report of case(s) A 17-year-old female with PWS, obesity, type II diabetes mellitus, developmental delay and severe OSA, non-adherent to positive airway pressure (PAP) therapy, presented with 6 months of pedal edema, weight gain with acute shortness of breath, fatigue, and decreased appetite. Upon arrival she developed hypoxemic, hypercapnic respiratory failure requiring intubation. Echocardiogram two months prior to admission showed normal right ventricular size and function with normal septal configuration. Echocardiogram after intubation showed signs of PH with dilated and hypokinetic ventricles compared to prior exam, worsening tricuspid valve regurgitation, and septal bowing. Sleep history was notable for severe OSA in 2017 with obstructive apnea-hypopnea index (oAHI) of 22.6, oxygen nadir of 74%, peak transcutaneous pCO2 of 51 mmHg. Patient was lost to follow-up and as per our history, was non-adherent to PAP therapy. On admission she was started on aggressive diuresis and tadalafil. After successful extubation to BPAP and wean to room air while awake, a BPAP titration PSG was performed. It demonstrated low baseline oxygen saturations (93%), an oxygen nadir of 70%, transcutaneous CO2 peak of 57mmHg with obstructive events eliminated with BPAP of 24/14 cmH20 and hypoxemia treated with 4L supplemental oxygen. With adequate respiratory support with sleep combined with PH monotherapy, repeat echocardiogram prior to discharge showed improved systolic function and only mild septal flattening. Conclusion It is unclear the prevalence of PH in patients with PWS independent of OSA, however it is likely increased overall secondary to the increased prevalence of OSA. As a result, patients with PWS may benefit from routine interval echocardiogram to monitor for signs of PH. Support (if any):

scholarly journals 1217 Obesity Hypoventilation Syndrome in a 4-Year-Old Child

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A465-A465
Author(s):  
Grace Wang ◽  
Jay Guevarra ◽  
Jason Bronstein
Keyword(s):  
Pulmonary Hypertension ◽  
Case Reports ◽  
Right Atrial ◽  
Pediatric Endocrinology ◽  
Low Oxygen ◽  
Obesity Hypoventilation Syndrome ◽  
Presenting Symptoms ◽  
Obstructive Sleep ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

Abstract Introduction four-year-old boy with morbid obesity was referred to pediatric sleep for nocturnal hypoxemia during inpatient admissions. He was found to have daytime hypoventilation, likely secondary to obesity hypoventilation syndrome (OHS). Report of Case During two inpatient admissions (wheezing, gastroenteritis), he desaturated to the 70s during sleep. At home, he received blow-by oxygen as he could not tolerate other interfaces. He underwent adenotonsillectomy. However, snoring, daytime sleepiness, hyperactivity and aggressive behavior persisted. Birth history was unremarkable, though he became progressively more obese over time. His father had obesity and obstructive sleep apnea. Physical exam was notable for elevated blood pressure of 122/68 mmHg (above 99th percentile), weight and height above 99th percentile, and BMI of 32 kg/m2 (z-score ~4.3). Despite extensive counseling, family declined polysomnography and labs. Awake end-tidal CO2s were elevated at 47 mmHg. Echocardiogram showed half-systemic PA pressures, right ventricular hypertrophy, and right atrial dilation. Family began desensitization protocol in preparation for future PAP therapy and polysomnography. Pediatric endocrinology consultation revealed low suspicion for hormonal/metabolic concerns. He entered a pediatric weight loss program. Conclusion This 4-year-old boy demonstrated daytime hypoventilation, systemic and pulmonary hypertension, likely consequences of his severe obesity. OHS is defined as BMI &gt;95th percentile in children and awake hypercapnia (PaCO2 &gt; 45 mmHg) in absence of alternative hypoventilation causes (e.g. pulmonary, cardiac, neurologic, pharmacologic). Presenting symptoms may include hypersomnolence, morning headaches, cognitive deficits, and signs of cor pulmonale1. The literature consists primarily of case reports; prevalence of pediatric OHS is unknown. Obesity afflicts 18.5% of children in the United States2. Given the severity of OHS sequelae, maintaining a high index of suspicion is crucial. Consider further work-up in patients with unexplained low oxygen saturations, signs of pulmonary hypertension (unexplained dyspnea on exertion, pedal edema), polycythemia, and elevated bicarbonate1.

scholarly journals 1267 Severe Obstructive Sleep Apnea in Patient with Large Multinodular Goiter

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A482-A482
Author(s):  
Maria Macias ◽  
Ritwick Agrawal
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Supplemental Oxygen ◽  
Apnea Hypopnea Index ◽  
Thyroid Lobe ◽  
Airway Narrowing ◽  
Superior Mediastinum ◽  
Obstructive Sleep ◽  
Titration Study

Abstract Introduction Obstructive sleep apnea (OSA) is characterized by upper airway narrowing or closure during sleep. Age and obesity are common contributors, but large thyroid goiters have also been shown to contribute to OSA. Report of Case We report a case of a 65 year-old-man (BMI 47 kg/m2) who presents with dyspnea and intolerance to PAP therapy. He had a slowly progressive goiter which was first noticed at age 45. He declined thyroidectomy due to concern of complications. A recent CT reported markedly enlarged thyroid (right thyroid lobe 10.9 x 8.5 cm, left thyroid lobe 7.0 x 6.5 cm and thyroid isthmus 4.0 cm). It had extension into the superior mediastinum and circumferential encasement of the subglottic trachea with effacement involving the lateral walls. In past, he was non-tolerant with BPAP therapy due to high pressure settings (24/14 cm water). Multiple attempts to desensitize were not successful. Most recent diagnostic polysomnography reported an apnea hypopnea index (AHI) of 35.2/ hour, oxygen nadir of 77%. Supplemental oxygen was titrated upward to 5 LPM due to persistent oxygen desaturations in the absence of obstructive events. In the PAP titration study, despite multiple efforts and patient’s poor tolerance, the titration study was suboptimal. He was titrated to BPAP 15/11 and still had a residual AHI of 28.4/hour. Considering these findings thyroidectomy was again discussed which could potentially reduce OSA severity significantly. After long discussion, unfortunately the patient declined this recommendation. Other surgical options such as hypoglossal nerve stimulation was not technically feasible due to large goiter. Ultimately, he decided to remain on nightly supplemental oxygen. Conclusion Large multinodular goiters with retropharyngeal extension can worsen obstructive sleep apnea and pose unique diagnostic and therapeutic challenges. In this case, thyroidectomy may have led to improvement of degree of sleep disordered breathing.

scholarly journals OPPORTUNITIES FOR EARLY OUTPATIENT DIAGNOSTICS OF OBSTRUCTIVE SLEEP DISORDERED BREATHING

2018 ◽  
Vol 17 (3) ◽  
pp. 38-45
Author(s):  
V. N. Larina ◽  
T. N. Mironova ◽  
E. M. Elfimova ◽  
T. A. Alekseeva ◽  
I. V. Starostin ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Daytime Sleepiness ◽  
Sleep Disordered Breathing ◽  
Respiratory Disorder ◽  
Diagnostic Instruments ◽  
Nocturnal Hypoxemia ◽  
Obstructive Sleep ◽  
Chronic Hypoxemia ◽  
Obstructive Sleep Disordered Breathing ◽  
Disordered Breathing

Aim. To evaluate the prevalence of possible obstructive respiratory disorder during sleep in outpatients by the data from computed monitoring pulse oxymetry (CPO) and questionnaires.Material and methods. To the open one stage non-randomized comparative study, 175 patients included: 37,1% males, 62,9% females, age 55,1±11,1 y.o., visiting a clinician office at outpatient facility. Sleep disordered breathing of obstructive origin was diagnosed with a survey, modified Stradling questionnaire and CPO; and excessive daytime sleepiness — with Epworth score. For confirmation of obstructive sleep apnea (OSA), a bifunctional monitoring was performed (BM) with further comparison of the data with CPO results.Results. Chronic hypoxemia at night by CPO was found in 71,4% patients, and probability of OSA moderate and severe — in 42,8% patients. By the modified Stradling, OSA was predicted in 57,7%, by Epworth, the daytime sleepiness was found in 11,4%. Mild OSA in BM was found in 8,9%, moderate — 14,7%, severe — 20,6%. The data from CPO matched with BM in 80% patients. Sensitivity of CPO for nocturnal hypoxemia of various severity was 92,4%, specificity — 76,4%; sensitivity of the Stradling questionnaire — 88,9%, specificity — 88,2%. Sensitivity of Epworth score — 27,8%, specificity — 82,4%.Conclusion. Chronic nocturnal hypoxemia was found in 71,4%, and probability of moderate and severe OSA — in 42,8% in outpatients with internal diseases profile. CPO and Stradling questionnaire can be applied as diagnostic instruments for OSA at outpatient stage.

scholarly journals New Predictive Equation for Optimal Continuous Positive Airway Pressure in Adult Patients with Obstructive Sleep Apnea

2021 ◽  
Author(s):  
Kanokkan Pengsakul ◽  
Krongthong Tawaranurak ◽  
Chuanchom Bumrungsena ◽  
Chitladda Chaimongkol ◽  
Jarurin Pitanupong
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Prediction Equation ◽  
P Value ◽  
Cpap Titration ◽  
Obstructive Sleep ◽  
Titration Study

Objective: This study aimed to develop and validate a new continuous positive airway pressure (CPAP) prediction equation and compare it with other formulas.Material and Methods: We retrospectively included patients with obstructive sleep apnea who underwent a CPAP titration study between January 2012 and December 2016. All clinical and polysomnographic data were collected. The new prediction equation was developed using the first data set, and the predictability performance was validated using the second data set.Results: Among the 266 enrolled patients, 73.7% were male, and the mean body mass index (BMI) was 30.8±7.4 kg/m2 . Five variables, namely age, BMI, neck circumference (NC), apnea–hypopnea index (AHI), and minimum pulse oxygen saturation (Min SpO2 ), highly correlated with the optimal titration pressure, and were therefore included in the equation, as stated below:Predicted pressure (cm H2 O) = 2.26 + (0.02xAge) + (0.04xBMI) + (0.11xNC) + (0.04xAHI) - (0.04xMin SpO2 )This equation accounted for 54.4% of the variance in predicting the optimal titration pressure (R2 =0.544, p-value <0.001). Its optimal estimation was 62.0% in the validated group. The equation-derived predicted pressure correlated with good agreement with the laboratory-derived optimal titration pressure (r=0.70, 95% CI=0.6335–0.755, p-value<0.001) according to Bland–Altman analysis. Conclusion: Our equation is highly consistent with the CPAP titration study in predicting fixed CPAP pressure, and is thereby beneficial for sleep technicians in establishing a starting pressure for such studies at a sleep laboratory.

An Overnight Rhythmic Sleep-Wake Pattern in Stroke and Obstructive Sleep Apnea: A Case Report and Literature Review

2020 ◽  
Author(s):  
Hamed Amirifard ◽  
Arezu Najafi ◽  
Ania Rahimi-Golkhandan ◽  
Mahsa Shojaie
Keyword(s):  
Obstructive Sleep Apnea ◽  
Case Report ◽  
Sleep Apnea ◽  
Comorbid Condition ◽  
Cpap Titration ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Sleep Breathing Disorder ◽  
History Of ◽  
Titration Study

Background and Objective: Obstructive sleep apnea (OSA) is a common sleep breathing disorder and a comorbid condition in patients with stroke. The prevalence of sleep disorders as a stroke consequence is high. Being independent of vascular risk factors, OSA is associated with increased risk of ischemic stroke. Here, we report a patient with OSA and stroke. Case Report: This case report presents a patient with a history of stroke and hemiparesis who underwent polysomnog-raphy (PSG) for evaluating OSA because of snoring, witnessed apnea, and excessive daytime sleepiness (EDS). Then the subject underwent continuous positive airway pressure (CPAP) titration for treating OSA. In first night of PSG, there was a repetitive cyclic pattern of sleep and arousals. After CPAP titration study and with CPAP pressure of 15 cmH2o, OSA and rhythmic changes of electroencephalography (EEG) were resolved. Conclusion: OSA as a risk factor for stroke can be associated with PSG cyclic wake-sleep pattern in these patients, and this pattern can be resolved by CPAP therapy.

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