1067 Narcotic Associated Bradypnea Mimicking Central Sleep Apnea

Introduction Bradypnea is slow breathing that is usually defined as less than 12 breaths per minute. Central apnea is characterized by a lack of drive to breathe during sleep. It is important to distinguish between the two as it can affect management. Report of Case The patient is a 72 year-old man with history of hypertension, diabetes mellitus, chronic obstructive pulmonary disease, coronary artery disease, coronary artery bypass graft, and posterior laminectomy from T10 to L1. He presented for evaluation of obstructive sleep apnea, with non-restorative sleep and excessive daytime sleepiness, with Epworth Sleepiness Scale score of 11/24. He is on fentanyl 25 mg transdermal patch every 72 hours for back pain. On physical examination lung fields were clear to auscultation bilaterally. Split night polysomnography revealed diagnostic portion total sleep time (TST) respiratory disturbance index of 93.1 events per hour, and oxygen saturation nadir of 78%. In the continuous positive airway pressure (CPAP) titration portion of the recording, sleep disordered breathing burden greatly improved, but on CPAP flow channel persistent bradypnea was noted, and occasionally the period between breaths met the American Academy of Sleep Medicine (AASM) scoring manual 10-second threshold for central apnea. Conclusion This patient had bradypnea mimicking central sleep apnea evident during titration portion of the split night polysomnography, occasionally meeting criteria for central sleep apnea. Recognition of bradypnea is crucial because misinterpretation as central apnea may dramatically affect the treatment option chosen, such as adaptive servo-ventilation versus CPAP. Our report represents clear visualization of this commonly discussed yet rarely published phenomenon.