A 48-Year-Old Athletic Man With Bradycardia During Sleep

Area of Science:

• Cardiology
• Sleep Medicine
• Internal Medicine

Background:

• A 48-year-old male with a history of dyslipidemia and Mobitz type I 2:1 atrioventricular block presented with sleep-related issues.
• The atrioventricular block was diagnosed 11 years prior following evaluation for nonanginal chest pain.

Observation:

• The patient reported fragmented sleep, nighttime awakenings, and non-restorative sleep.
• He experiences daytime sleepiness and evening somnolence.
• Despite being highly athletic, his wife noted loud snoring and apneic episodes during sleep.
• A sibling has a history of obstructive sleep apnea (OSA).

Findings:

• The patient's subjective sleep complaints and observed apneic episodes, coupled with a family history of OSA, raise suspicion for obstructive sleep apnea.
• His low Epworth Sleepiness Scale score (2) may not fully capture the extent of his sleep impairment.

Implications:

• This case highlights the importance of considering obstructive sleep apnea in athletic individuals with cardiac conditions and sleep disturbances, even with low reported daytime sleepiness.
• Further investigation, such as polysomnography, is warranted to confirm or exclude OSA and guide appropriate management.
• Undiagnosed OSA can have significant cardiovascular implications, potentially exacerbating existing conditions like dyslipidemia and atrioventricular block.