Issue Navigator

Volume 14 No. 05
Earn CME
Accepted Papers

Case Reports

The Longest Obstructive Apnea You Have Ever Seen: A Patient With New-Onset Autonomic Dysfunction

Puneet K. Aulakh, MD1; David E. Westerman, MBChB, FCP(SA), FCCP, FAASM2; Raj C. Dedhia, MD, MS3,4
1Emory Sleep Center, Emory University School of Medicine, Atlanta, Georgia; 2Sleep Disorders Center, Northside Hospital, Atlanta, Georgia; 3Emory Sleep Center, Emory Healthcare, Atlanta, Georgia; 4Department of Otolaryngology, Emory University, Atlanta, Georgia

Autonomic dysfunction (AD) has been associated with both obstructive and central sleep apneas. Several mechanisms have been proposed for the emergence of sleep apnea in AD, which include impaired sensory input, compromised local reflexes, and altered central processing. We present a case of a 70-year-old woman who had experienced cardiac arrest four times related to hypoxic events due to the apparent sudden onset of obstructive sleep apnea (OSA) in the setting of AD. The episodes of OSA were profoundly prolonged and a tracheostomy was ultimately needed due to the inability of positive airway pressure therapy with supplemental oxygen to control events. We think that this case is unique because of the extreme duration of the obstructive apneas (up to 233.8 seconds), which almost certainly reflects lack of protective autonomic control in terminating these events.


Aulakh PK, Westerman DE, Dedhia RC. The longest obstructive apnea you have ever seen: a patient with new-onset autonomic dysfunction. J Clin Sleep Med. 2018;14(5):893–895.

Please login to continue reading the full article

Subscribers to JCSM get full access to current and past issues of the JCSM.

Login to JCSM

Not a subscriber?

Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership

Subscribe to JCSM:  $75/volume year for individuals or $140/volume year for institutions to access all current articles and archives published in JCSM.

Download this article*:   $20 to access a PDF version of a specific article from the current issue of JCSM.

*Purchase of an electronic download of JCSM provides permission to access and print the issue/article for personal scholarly, research and educational use. Please note: access to the article is from the computer on which the article is purchased ONLY. Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM. Further, purchase does not permit the posting of article text on an online forum or website.