Adaptive servo-ventilation for the treatment of intrathecal baclofen-induced central sleep apnea: A case report

Baclofen is a common muscle relaxant agent used in a number of neurological disorders acting at central level and potentially causing adverse respiratory events, still largely unknown at therapeutic doses. We present the case of a young woman with spastic tetraparesis secondary to perinatal asphyxia treated with a standard dose of intrathecal baclofen who developed nocturnal symptoms, somnolence and memory loss during the day. Nocturnal cardio-respiratory sleep monitoring showed a high number of central sleep apneas (CSA). The patient was adapted and treated with a positive air pressure device, Adaptative Servo-Ventilator, specific designed to treat CSA particularly in patients with heart failure. The treatment was well tolerated and within few days CSA was reversed. The patient reported a feeling of restful sleep and disappearance of morning tiredness. The efficacy of the treatment was verified with nocturnal cardio-respiratory monitoring after 2 months and complete resolution of all symptoms was also confirmed.