An 82-Year-Old Man With Sleep-Onset Insomnia, Breathing Arrest, and Heart Failure

An 82-year-old man presented with 6 months of difficulties of falling asleep. He described a feeling of fading breath culminating in breathing arrest when he becomes drowsy. These recurrent events prevented him from falling asleep. Symptoms would only appear when he went to sleep but not during wakefulness. Medical history comprised several episodes of acute decompensated heart failure due to supraventricular tachyarrhythmia with need for hospitalization during the last 2 years. He additionally had two-vessel coronary artery disease with myocardial infarction, pulmonary hypertension, chronic atrial fibrillation, peripheral arterial disease, and chronic kidney disease (stage 3). Medication included diuretics, sodium bicarbonate, angiotensin II receptor antagonist, beta-blocker, statin, clopidogrel, and phenprocoumon without sedatives or analgesics.