Chest

Chest

Volume 149, Issue 5, May 2016, Pages e127-e131
Journal home page for Chest

Selected Reports
Severe Central Sleep Apnea Associated With Chronic Baclofen Therapy: A Case Series

https://doi.org/10.1016/j.chest.2015.10.001Get rights and content

Baclofen, a gamma-aminobutyric acid-B agonist with muscle-relaxant properties, is widely used in patients with severe spasticity. In animals, baclofen has been shown to decrease respiratory drive. In humans, however, use of baclofen at the standard dose did not significantly impair sleep-disordered breathing in a susceptible population of snorers. Recently, there has been increasing interest in the role of baclofen for the treatment of alcohol dependence. We describe severe central sleep apnea (CSA) in four patients with none of the conditions commonly associated with CSA who were receiving chronic baclofen therapy for alcohol withdrawal. In one patient, baclofen withdrawal was associated with a complete resolution of CSA. Three patients were treated by adaptive servo-ventilation while continuing their treatment with baclofen. Given the increasing number of patients receiving baclofen for alcohol withdrawal treatment, physicians should be aware that these patients might be affected by severe CSA. Future studies are required to determine the mechanisms, prevalence, and treatment modalities of sleep-disordered breathing associated with baclofen usage.

Section snippets

Case Reports

Four male patients aged 46 to 70 years treated with baclofen 40 to 190 mg/d for alcohol withdrawal underwent overnight polysomnography (n = 2) or respiratory recording (n = 2) for symptoms of sleep apnea; these symptoms included snoring, nocturnal choking, and daytime sleepiness (Table 1). Their other medications included antidepressants (n = 4), neuroleptic agents (n = 1), and anxiolytic and hypnotic drugs (n = 3). None of the patients had a history of cardiac disease, and one patient had a

Discussion

To the best of our knowledge, this case series is the first describing severe CSA attributed to chronic baclofen therapy. Several arguments have led us to conclude that the episodes of SDB were secondary to baclofen exposure. The patients in our study had none of the conditions commonly associated with CSA, including cardiac diseases, daytime hypocapnia or hypercapnia, alkalosis, opioid use, or CPAP therapy.8 The complete resolution of SDB after baclofen withdrawal in patient 4 provides strong

Conclusions

Given the increasing number of patients undergoing long-term baclofen therapy for alcohol disorders, physicians should be aware that these patients might be affected by severe CSA. Future studies are required to determine the mechanisms, frequency, and treatment modalities of SDB associated with baclofen use.

Acknowledgments

Author contributions: P.-Y. O., F. G., and J.-L. P. researched the data, contributed to the discussion, wrote the manuscript, and reviewed/edited the manuscript. M. J.-F., T. G., S. H. L., and M. P. D. researched the data, contributed to the discussion, and reviewed/edited the manuscript.

Financial/Nonfinancial disclosures: The authors have reported to CHEST the following: M. P. D. is a consultant for Resmed and IPSanté; has participated in speaking activities for Orkyn, Resmed, Philips, and

References (20)

There are more references available in the full text version of this article.

Cited by (0)

Drs Pépin and Gagnadoux contributed equally to this publication.

View full text
© 2015 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.