Obstructive Sleep Apnea Presenting as Non-epileptic Spells: A Unique Combination.

Area of Science:

• Neurology
• Sleep Medicine
• Pulmonology

Background:

• Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated airway collapse during sleep.
• While typically presenting with snoring and witnessed apneas, OSA can manifest with atypical symptoms.
• This case highlights an unusual presentation of OSA mimicking seizure-like events.

Observation:

• A 61-year-old male with a history of seizure-like events presented for evaluation.
• Continuous video electroencephalogram (vEEG) monitoring revealed spells triggered by sleep arousals associated with apneic events.
• The patient had recently been diagnosed with obstructive sleep apnea but was not yet on treatment.

Findings:

• All observed seizure-like spells were directly linked to arousal from sleep and apneic events.
• Initiation of positive airway pressure (PAP) therapy led to a marked decrease in the frequency and severity of these spells.
• The seizure-like events were determined to be non-epileptic, stemming from OSA-related arousals.

Implications:

• This case underscores the importance of considering OSA in the differential diagnosis of seizure-like events.
• Effective management of OSA with PAP therapy can resolve or significantly improve these atypical spell presentations.
• Further research into the neurophysiological link between sleep apnea and non-epileptic seizures is warranted.