Case Report: Hypertensive encephalopathy presents with complex types of sleep breathing events

Obstructive sleep apnea (OSA) is a common sleep disorder and one of the common causes of secondary hypertension. Patients with this condition often have characteristics such as reverse spoon-shaped blood pressure patterns and poor response to multiple drug treatments. Patients often attribute morning dizziness and fatigue to poor sleep quality, while neglecting the diagnosis and control of hypertension. Hypertensive encephalopathy (HE) is a hypertensive emergency, which may present with symptoms such as headache, vomiting, and epileptic-like seizures due to increased intracranial pressure. The impact of hypertension on sleep has not been reported in the literature.

A 43-year-old male patient complained of having experienced elevated blood pressure for two years, and his blood pressure was poorly controlled without any monitoring. The patient had no family history of hypertension, and found that the blood pressure was not controlled after increasing blood pressure, and then came to the hospital for treatment due to the sudden increase of blood pressure, accompanied by dizziness and headache. During the hospitalization, the patients used various drugs with poor antihypertensive effect, and after examining the hypertension-related causes, it pointed to sleep dyspnea-related hypertension. During this period, the patient developed HE, sleep breathing disorder changed from obstructive to central, and tidal breathing appeared at the same time. After various non-invasive ventilator modes and pressure titration, the patient was treated and discharged from hospital.

Patients with HE may experience complex types of sleep breathing disorders, which further lead to intermittent or persistent hypoxemia, making it difficult to control blood pressure and potentially damaging various organs throughout the body. During the period of providing respiratory support for such patients, it is necessary to pay attention to the supply of oxygen and the setting of ventilation modes for the current sleep breathing disorders. In cases where necessary, a multidisciplinary collaborative diagnosis involving sleep experts, respiratory experts, and neurology experts should be conducted.