Effect of Deep Brain Stimulation on a Patient With Obstructive Sleep Apnea and Parkinson Disease: A Case Report

March 2014, Vol 145, No. 3_MeetingAbstracts Sleep Disorders | March 2014

Effect of Deep Brain Stimulation on a Patient With Obstructive Sleep Apnea and Parkinson Disease: A Case Report Margarida Dias, MD; Ana Antunes, MD Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal

Chest. 2014;145(3_MeetingAbstracts):570A. doi:10.1378/chest.1825727

Abstract SESSION TITLE: Sleep Case Report Posters SESSION TYPE: Case Report Poster PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM INTRODUCTION: Parkinson's disease (PD) is associated to several sleep disturbances including obstructive sleep apnea syndrome (OSAS). CASE PRESENTATION: A 68 year-old non-smoking woman with advanced stage of idiopathic PD, usually medicated with selegiline 1.25mg 1id, ropinirole 8mg 1id, levodopa 25mg/carbidopa 100mg 8id, bromazepam 3mg 1id and trazodone 150mg 1id. Patient was referred to a Pneumonology Consultation of our Hospital in 2009 due to snoring, nocturnal arousals with asphyxiation feeling, symptoms of restless legs and excessive day sleepiness (EDS) - Epworth Sleepiness Scale (ESS): 15/21. The cardiorespiratory sleep study showed apnea-hypopnea index (AHI): 21.4/h; minimum O2 saturation: 74%. Patient started nocturnal PAP therapy but with poor compliance due to mouth dryness and sleep fragmentation caused by a feeling of high pressure in the airway. From 2009 to 2011 the PD worsened with increased stiffness, bradykinesia and tremors. The sleep circadian rhythm was also affected. In 2011 the patient was submitted to a surgery for implantation of a deep brain stimulator of the subthalamic nucleus (DBS-STN). After surgery there was a clear improvement of motor symptoms (no muscular stiffness, mild bradykinesia, mild neck dystonia) and the dosage of dopaminergic medication was reduced. Patient also reported an improvement of the snoring, no witnessed apneas and nocturnal arousals, lack of

restless legs symptoms and periodical limbs movements during sleep. She presented repairing sleep (ESS=3) and the polysomnography parameters improved (AHI: 4.1/h, minimum O2 saturation: 94%) without detection of periodical limbs movements. The significant improvement in her sleep quality was interpreted in the context of the DBS-STN implantation and, once there were no longer criteria of OSAS, patient was discharged from the Pneumonology Consultation. DISCUSSION: In PD, the long term DBS-STN can improve motor symptoms and reduce the dosage of dopaminergic medication. Furthermore, recent studies show a subjective and objective improvement of the sleep quality with this treatment, as observed. CONCLUSIONS: This case report highlights the possibility of sleep improvement by implanting a DBS-STN in PD patients with criteria for its use and with OSAS. Reference #1: Amara AW, Watts RL, Walker HC: The effects of deep brain stimulation on sleep in Parkinson's disease. Ther Adv Neurol Disord 4(1):15-24, 2011. Reference #2: Cochen De Cock V, Abouda M, Leu S: Is obstructive sleep apnea a problem in Parkinson's disease?. Sleep Med 11(3):247-52, 2010. Reference #3: Dhawan V, Healy DG, Pal S, Chaudhuri KR: Sleep-related problems of Parkinson's disease. Age Ageing. 35(3):220-8, 2006. DISCLOSURE: The following authors have nothing to disclose: Margarida Dias, Ana Antunes No Product/Research Disclosure Information