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A 67-year-old man with a history of epilepsy, cardiac failure, alcohol dependence, and hypercholesterolemia underwent a polysomnogram (PSG) study because of snoring and observed apnea during sleep. Body mass index was recorded at 25.9 kg/m2. Medications included metoprolol, valsartan, simvastatin, phenytoin, valproate, and levetiracetam. Prior echocardiogram had shown an ejection fraction of 35%. PSG showed an overall Central Apnea Index (CAI) of 18, with 18 central apneas/hour, 7 hypopneas/hour, 0 mixed apneas/hour, and 0 obstructive apneas/hour (figure 1). Central apneas displayed a crescendo-decrescendo pattern, consistent with CSB. Because of recurrent seizures, topiramate was added to the medication regimen, with a titration schedule to 100 mg twice per day. After 5 months, a second PSG for titration with adaptive servo-ventilation was obtained. Baseline portion of the study (about 90 minutes) showed a significant decrease in number of central apneas, with an overall CAI of 0, with 0 central apneas/hour, 12 hypopneas/hour, 0 mixed apneas/hour, 0 obstructive apneas per hour of sleep, and …

Pearls & Oy-sters: Treatment of central sleep apnea with topiramate