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CPAP maladaptation due to parasomnia: case report


Obstructive sleep apnea (OSA) has a major cardiovascular impact. Continuous positive airway pressure (CPAP) therapy is an effective treatment for OSA which has given the best outcomes until now. Many studies have shown that CPAP treatment depends on the patient, technological device, side effects, and psychological and social factors


To report the case of a patient who was unable to use CPAP due to possible parasomnia and cognitive decline.


We carried out a longitudinal follow-up of an elderly woman, through regular consultations, of her CPAP adaptation and her response to prescribed medications


A 79-year-old woman, hypertensive, diabetic, carrier of vascular cognitive decline, was diagnosed with obstructive sleep apnea (OSA) severe (Apneia Hypopneia Index AIH 36.9). She started treatment with CPAP. Initially, she had a good adherence, using the device for more than 4 hours daily. Her AHI was 1.6. However, one year after, she related bad adherence, big breakout rate, with increase of AHI. She at this time presented excessive daytime sleepiness, unrefreshing sleep. There was a worsening of her cognitive condition with a drop of 5 points on the mini-mental state exam (MMSE). On evaluation, she said that removed CPAP while slept. She remained with bad adherence until this year when we collected history. Talking to her husband, we found that she often got out of bed asleep and had nightmares. The husband even locked the bedroom’s door to avoid accidents. This usually happened at the beginning of the night. We raised the hypothesis of sleep parasomnia of non-rapid eye movement sleep. We started clonazepam low dose. She evolved with longer use of CPAP and her AHI decreased. However, considering the adverse effects, we replaced it with melatonin. She is still under follow-up


Parasomnias can be associated with OSA. Pharmacological treatment can help improve CPAP adaptation.


Parasomnia ; CPAP; adherence


Relato de Caso


Hospital Universitário Walter Cantídio - Ceará - Brasil


Danielle Mesquita Torres, Alissa Elen Formiga, Isabella de Melo Matos, Camila Ferreira Leite, Manoel Alves Sobreira- Neto