[Life-threatening apnea after midazolam administration in a patient with obstructive sleep apnea syndrome]

In a 27-year-old patient with a severe obstructive sleep apnea syndrome documented by a polysomnographic study, an oral dose of 15 mg midazolam caused life-threatening obstructive apnea and excessive sedation. Therapy with nasal CPAP eliminated the pharyngeal obstruction, but marked central hypoventilation persisted. Benzodiazepines are known to aggravate the obstructive sleep apnea syndrome. Dangerous central hypoventilation occurring after this medication during treatment with nasal CPAP has not yet been reported. Excessive susceptibility to depression of chemoresponsiveness to pCO2 is suspected. The potentially dangerous and life-threatening side effects of sedatives in patients with obstructive sleep apnea syndrome are discussed.