Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France.
Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France Inserm UMR 1063, Université d'Angers, Angers, France.
J Clin Sleep Med. 2019 Aug 15;15(8):1179-1182. doi: 10.5664/jcsm.7818.
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.
替格瑞洛是一种 P2Y12 受体拮抗剂，与阿司匹林联合用于冠心病患者。最近的报告表明，替格瑞洛可能通过增加对高碳酸血症的化学敏感性而诱发中枢性睡眠呼吸暂停（CSA）。我们在此描述了一例经正压通气（PAP）治疗的阻塞性睡眠呼吸暂停（OSA）患者的病例，在该患者中，在起始替格瑞洛治疗射血分数保留的急性冠状动脉综合征后，通过 PAP 远程监测发现 CSA 和 Cheyne-Stokes 呼吸（CSR）的出现。在 PAP 撤离后，通过呼吸描记法证实了替格瑞洛相关的 OSA 向 CSA 的转变，并与高碳酸血症化学敏感性增加有关。替格瑞洛停药与单纯 OSA 的复发和高碳酸血症通气反应的正常化有关。在意外重新引入该药物后，通过 PAP 远程监测发现 CSA 和 CSR 短暂复发。需要进一步的研究来确定替格瑞洛相关 CSA 的发生机制、发生率和后果。
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.
