The Longest Obstructive Apnea You Have Ever Seen: A Patient With New-Onset Autonomic Dysfunction

Autonomic dysfunction (AD) has been associated with both obstructive and central sleep apneas. Several mechanisms have been proposed for the emergence of sleep apnea in AD, which include impaired sensory input, compromised local reflexes, and altered central processing. We present a case of a 70-year-old woman who had experienced cardiac arrest four times related to hypoxic events due to the apparent sudden onset of obstructive sleep apnea (OSA) in the setting of AD. The episodes of OSA were profoundly prolonged and a tracheostomy was ultimately needed due to the inability of positive airway pressure therapy with supplemental oxygen to control events. We think that this case is unique because of the extreme duration of the obstructive apneas (up to 233.8 seconds), which almost certainly reflects lack of protective autonomic control in terminating these events.