Obstructive sleep apnea presenting as recurrent cardiopulmonary arrest

A non-obese patient who was admitted initially with hypoglycemia had multiple episodes of cardiopulmonary arrests requiring resuscitations and a short period of mechanical ventilation. A subsequent sleep study confirmed the diagnosis of severe obstructive sleep apnea (OSA) and documented an episode of near-arrest with cerebral hypoxia during rapid eye movement sleep. We suggest that OSA coupled with impairment of arousal response and other apnea termination mechanisms had resulted in prolonged apnea, life-threatening hypoxemia, and cardiopulmonary arrest in this patient. We review the current understanding of the mechanisms of apnea termination in OSA and suggest that further studies are needed to investigate these mechanisms and their roles in sudden death during sleeping hours in patients with OSA.