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Baclofen-Associated Onset of Central Sleep Apnea in Alcohol Use Disorder: A Case Report

机译:酒精使用障碍中与巴氯芬有关的中枢性睡眠呼吸暂停发作:一例报告。

摘要

A 61-year-old patient with alcohol use disorder (AUD) was referred for suspicion of sleep apnea syndrome (SAS). He had incurred three road accidents attributed to sleepiness over the previous year, shortly after initiation of high-dose (100 mg b.i.d.) treatment with baclofen, a molecule increasingly used in the management of AUD. Polysomnography revealed a severe central SAS (CSAS) with an apnea-hypopnea index (AHI) of 81.6/h. Baclofen was suggested as a possible cause of the CSAS, and after its withdrawal, a second polysomnography was done, showing the disappearance of the central apneas and a shift to severe obstructive SAS (AHI 43.9/h), for which a positive airway pressure (CPAP) treatment was initiated. A third polysomnography was performed under CPAP after reintroduction of baclofen (50 mg b.i.d.) by the patient, showing reappearance of the CSAS (AHI 42.1/h). This case report illustrates the deleterious effect of baclofen on breathing physiology during sleep. Since it is typically prescribed off label at high doses to a population of patients potentially using other substances that inhibit the ventilatory drive, this possible adverse effect is a major concern. When considering the use of baclofen in patients with AUD, the potential for sleep-disordered breathing should be weighed and carefully monitored.
机译:一名61岁的酒精滥用障碍(AUD)患者因涉嫌睡眠呼吸暂停综合症(SAS)而被转诊。在开始使用巴氯芬高剂量(100 mg b.i.d.)治疗后不久,他在上一年就发生了三起因昏昏欲睡的交通事故。巴氯芬是一种越来越多地用于治疗澳元的分子。多导睡眠图检查显示严重的中央SAS(CSAS),呼吸暂停-呼吸不足指数(AHI)为81.6 / h。有人建议将巴氯芬作为CSAS的可能病因,撤除巴氯芬后,应进行第二次多导睡眠监测,显示中枢性呼吸暂停消失,并转移至严重阻塞性SAS(AHI 43.9 / h),此时气道正压(开始CPAP治疗。患者再次引入巴氯芬(50 mg b.i.d.)后,在CPAP下进行了第三次多导睡眠监测,显示CSAS再次出现(AHI 42.1 / h)。该病例报告说明了巴氯芬对睡眠期间呼吸生理的有害作用。由于通常以高剂量将其标明处方给可能使用其他抑制通气驱动的物质的患者群体,因此这种可能的不利影响是一个主要问题。当考虑在患有AUD的患者中使用巴氯芬时,应权衡睡眠呼吸障碍的可能性并进行仔细监测。

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