1099 HYPOGLOSSAL NERVE STIMULATION AS SALVAGE TREATMENT FOR OSA IN A PATIENT WITH REFRACTORY DEPRESSION
Abstract Introduction Hypoglossal nerve stimulation (HGNS) improves obstructive sleep apnea (OSA) in carefully selected patients. We present a patient with refractory psychiatric illness and severe OSA with intolerance to CPAP, oral appliance, and bariatric surgery but who was successfully treated w...
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| Published in: | Sleep (New York, N.Y.) Vol. 41; no. suppl_1; p. A409 |
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| Main Authors: | , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
US
Oxford University Press
27-04-2018
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Abstract
Introduction
Hypoglossal nerve stimulation (HGNS) improves obstructive sleep apnea (OSA) in carefully selected patients. We present a patient with refractory psychiatric illness and severe OSA with intolerance to CPAP, oral appliance, and bariatric surgery but who was successfully treated with HGNS.
Report of Case
A 66-year-old female was referred for sleep apnea evaluation as a contributing factor to refractory anxiety and depression with psychosis. She was diagnosed with severe OSA (AHI: 34). Multiple attempts at CPAP therapy provoked intense emotional distress including tearful sobbing, despite cognitive behavioral therapy. She also failed oral appliance. She even underwent gastric bypass surgery with significant weight loss but repeat polysomnography re-demonstrated severe OSA. Finally, due to concerns that untreated OSA adversely impacted her psychiatric disease management, she underwent implantation of HGNS. HGNS resulted in a residual AHI of 6 at 1.8 volts. The patient currently demonstrates favorable adherence to HGNS resulting in improved sleep quality and duration along with modest improvements in her depression and anxiety. Multilevel surgical interventions for OSA have resulted in significant improvements in depression however, there is a paucity of evidence supporting the use of HGNS as treatment for OSA to improve psychiatric illness. Our case highlights HGNS as an effective treatment modality to treat OSA and to also reduce depression symptoms. HGNS may lead to improved mood over time as evidenced by previously reported improvement in the Beck Depression Inventory questionnaire.
Conclusion
HGNS should be considered for treatment of OSA in appropriately selected patients with psychiatric disorders and intolerance to PAP therapy. |
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| ISSN: | 0161-8105 1550-9109 |
| DOI: | 10.1093/sleep/zsy063.1098 |