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Case Reports
. 2019 Aug 15;15(8):1179-1182.
doi: 10.5664/jcsm.7818.

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

Caroline Paboeuf  1 , Pascaline Priou  2 , Nicole Meslier  2 , Frédéric Roulaud  3 , Wojciech Trzepizur  4 , Frédéric Gagnadoux  4
Affiliations
Case Reports

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

Caroline Paboeuf et al. J Clin Sleep Med. .

Abstract

None: 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.

Citation: 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.

Keywords: central sleep apnea; remote positive airway pressure-telemonitoring; ticagrelor.

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Figures

Figure 1
Figure 1. AHIFLOW and Cheyne-Stokes respiration measured by PAP device.
(A) Report of the evolution of apnea-hypopnea index (AHIFLOW) and Cheyne-Stokes respiration detected by remote positive airway pressure (PAP)-telemonitoring during the patient follow-up. (B) Cheyne-Stokes respiration over a 6-minute period recorded by the PAP device under ticagrelor therapy.
Figure 2
Figure 2. Distribution of obstructive, central, and mixed apneas on full-night respiratory polygraphy (RP) at diagnosis, under ticagrelor and after ticagrelor withdrawal.
See this image and copyright information in PMC

References

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