Obstructive Sleep Apnea: a possible differential diagnosis of epilepsy

Résumé

Introduction

Obstructive sleep apnea syndrome (OSA) is the most common respiratory sleep disorder, although it is overlooked by practitioners. Clinical symptoms may include loud snoring, witnessed apneas, unrefreshing sleep, daytime somnolence, or alteration of cognition. Syncope is a rare mode of revelation of OSA. We report a case of OSA revealed by syncope.

Case report

Mr BM, 52, married who consults for recurrent episodes of loss of consciousness of less than 2 minutes without loss of urine or bite of the tongue. In his history, we find obesity (BMI at 31) and a notion of night snoring. According to his wife's testimony, loss of consciousness occurs mainly in the morning upon waking and after each loss of consciousness, the patient is awakened by auditory stimulation and remembers the episode. The clinical examination did not find any particular anomaly. A syncope of cardiac origin was mentioned given the brief nature of the loss of consciousness and the absence of amnesia of the episode. Cardiac evaluation included holter electrocardiography, stress testing and ambulatory blood pressure monitoring showed no evidence of conduction disorder, arrhythmia, ischemia, or orthostatic fluctuations in blood pressure. he complete electroencephalographic exploration does not reveal any particular anomaly. Biological explorations were normal.
Polysomnography revealed loud snoring with an apnea-hypopnea index of 35 / h dominated by hypopnea events (index at 21.1 / h). The iterative sleep latency test (TILE) revealed an average sleep latency of 9 minutes 36 seconds, without REM sleep.
At the end of these explorations, the diagnosis of OSAS revealed by a syncope was retained. Continuous positive airway pressure therapy has improved symptoms.

Conclusion

Syncope is a rare and unusual presentation of SAOS. The pathophysiological mechanisms of syncope in OSA are not well understood. Screening for OSA should be standard practice in exploring for unexplained syncope.