Increase of respiratory events after treatment with Sodiumoxybat in a patient with narcolepsy and mild obstructive sleep apnoea syndrome (SAS): A case report

A 60 year old woman in early retirement, presented herself to our sleep laboratory. 29 years ago she had been diagnosed with narcolepsy and the reason for the consultation was a recent increase of affective cataplexies, hypersomnia and severe agonising nightmares. The polysomnography showed a low-level state-dependent sleep apnoea syndrome (SAS)additionally to the typical signs of narcolepsy (RDI=5/h). To protect the patient against the occurrence of cataplexies and nightmares, we started a medication with Sodiumoxybat. The patient received 4.5g of Sodiumoxybat in two single doses for three nights. Sodiumoxybat medication reduced the incidence of nightmares. Even though the patient did not complain of any other side effects, a marked increase of respiratory events was detected in the respiratory polysomnography (decreases in airflow of >50% and decline of oxygen levels of up to 2–3%). The respiratory events rose to more than 40/h with Sodiumoxybat medication. Treatment with Sodiumoxybat and nCPAP (10bar)improved the SAS but the incidence of respiratory events (including apnoea and hypopnoea) was still too high (28–29/h). In contrast to other publications who did not describe deterioration of SAS with Sodiumoxybat medication, we registered an increase of respiratory events in our patient. If Sodiumoxybat is used in patients with sleep related breathing disorders, the medical adjustment should therefore be undertaken under polysomnographic control in a sleep laboratory.