Perogamvros Lampros, Pépin Jean Louis, Thorens Gabriel, Mégevand Pierre, Claudel Elisabeth, Espa Fabrice, Besson Marie, Cervena Katerina, Janssens Jean-Paul, Lador Frédéric
Sleep Laboratory, Geneva University Hospitals, Geneva, Switzerland.
Respiration. 2015;90(6):507-511. doi: 10.1159/000439542. Epub 2015 Sep 22.
A 61-year-old patient with alcohol use disorder (AUD) was referred for suspicion of sleep apnea syndrome (SAS). He had incurred three road accidents attributed to sleepiness over the previous year, shortly after initiation of high-dose (100 mg b.i.d.) treatment with baclofen, a molecule increasingly used in the management of AUD. Polysomnography revealed a severe central SAS (CSAS) with an apnea-hypopnea index (AHI) of 81.6/h. Baclofen was suggested as a possible cause of the CSAS, and after its withdrawal, a second polysomnography was done, showing the disappearance of the central apneas and a shift to severe obstructive SAS (AHI 43.9/h), for which a positive airway pressure (CPAP) treatment was initiated. A third polysomnography was performed under CPAP after reintroduction of baclofen (50 mg b.i.d.) by the patient, showing reappearance of the CSAS (AHI 42.1/h). This case report illustrates the deleterious effect of baclofen on breathing physiology during sleep. Since it is typically prescribed off label at high doses to a population of patients potentially using other substances that inhibit the ventilatory drive, this possible adverse effect is a major concern. When considering the use of baclofen in patients with AUD, the potential for sleep-disordered breathing should be weighed and carefully monitored.
一名61岁的酒精使用障碍（AUD）患者因疑似睡眠呼吸暂停综合征（SAS）前来就诊。在开始使用高剂量（每日两次，每次100毫克）巴氯芬治疗后不久，他在过去一年中因嗜睡发生了三起交通事故。巴氯芬是一种越来越多地用于治疗AUD的药物。多导睡眠图显示严重的中枢性SAS（CSAS），呼吸暂停低通气指数（AHI）为81.6次/小时。巴氯芬被认为可能是CSAS的病因，停药后进行了第二次多导睡眠图检查，结果显示中枢性呼吸暂停消失，转变为严重的阻塞性SAS（AHI 43.9次/小时），为此开始了持续气道正压通气（CPAP）治疗。在患者重新服用巴氯芬（每日两次，每次50毫克）后，在CPAP治疗下进行了第三次多导睡眠图检查，结果显示CSAS再次出现（AHI 42.1次/小时）。本病例报告说明了巴氯芬对睡眠期间呼吸生理的有害影响。由于巴氯芬通常以高剂量超说明书用药，用于可能使用其他抑制通气驱动物质的患者群体，这种可能的不良反应是一个主要问题。在考虑对AUD患者使用巴氯芬时，应权衡睡眠呼吸障碍的可能性并进行仔细监测。
