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Volume 15 No. 08
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Accepted Papers

Case Reports

Ticagrelor-Associated Shift From Obstructive to Central Sleep Apnea: A Case Report

Caroline Paboeuf, MD1; Pascaline Priou, MD, PhD1,2; Nicole Meslier, MD1,2; Frédéric Roulaud, MD3; Wojciech Trzepizur, MD, PhD1,2; Frédéric Gagnadoux, MD, PhD1,2
1Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France;; 2Inserm UMR 1063, Université d’Angers, Angers, France;; 3Service de Cardiologie, Centre Hospitalier Universitaire, Angers, France

Ticagrelor, a P2Y12 receptor antagonist, is used in combination with aspirin in patients with coronary artery disease. Recent reports suggest that ticagrelor might induce central sleep apnea (CSA) by increasing chemosensitivity to hypercapnia. We herein describe the case of a patient with positive airway pressure (PAP)-treated obstructive sleep apnea (OSA), in whom PAP-telemonitoring revealed the emergence of CSA and Cheyne-Stokes respiration (CSR) after initiation of ticagrelor for an acute coronary syndrome with preserved left ventricular ejection fraction. Ticagrelor-associated shift from OSA to CSA was confirmed by respiratory polygraphy after PAP withdrawal, and was associated with an increased chemosensitivity to hypercapnia. Ticagrelor discontinuation was associated with the recurrence of pure OSA and the normalization of hypercapnic ventilatory response. A transient recurrence of CSA and CSR was identified by PAP-telemonitoring after accidental reintroduction of the drug. Further studies are required to determine the mechanisms, incidence, and consequences of ticagrelor-associated CSA.


Paboeuf C, Priou P, Meslier N, Roulaud F, Trzepizur W, Gagnadoux F. Ticagrelor-associated shift from obstructive to central sleep apnea: a case report. J Clin Sleep Med. 2019;15(8):1179–1182.

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