Reactions 1680, p274 - 2 Dec 2017
REM sleep rebound: case report
An adult man [exact age at reaction onset not stated]
developed REM sleep rebound following the withdrawal of
paroxetine [route and time to reaction onset not stated].
The 34-year-old man visited the sleep laboratory for heavy
snoring, tendency to fall asleep in non-demanding situations
and non-restorative sleep. Subsequently, he was diagnosed
with moderate obstructive sleep apnoea. He was
recommended for nasal surgery, diet and positional therapy.
After 16 years, he came back. He had undergone nasal surgery
12 years ago. He was diagnosed as a hypertensive 10 years ago
and currently treated with telmisartan, carvedilol and
hydrochlorothiazide. Five months before, he was initiated on
paroxetine 20 mg/day for the treatment of depressive
symptoms. He reported severe worsening of daytime
sleepiness and sleep quality, which introduced to a
fragmented and restless sleep. Nocturnal polysomnography
was performed and automated continuous positive airway
pressure (CPAP) was applied during the polysomnography. He
immediately fell asleep and showed a very short REM latency.
Later, most of his sleep was described by 71.6% REM of total
sleep time, while just few awakening and arousals occurred.
The CPAP use satisfactorily corrected respiratory disorders
during both REM and NREM sleep. Apnoea/hypopnea index
was 1.9, and lowest SaO
was 84%. However, mean SaO
during effective CPAP was 94%. The next day, when asked, he
mentioned that he had suddenly discontinued paroxetine
three days before. A new polysomnography was planned to
evaluate if the CPAP treatment and paroxetine withdrawal
could revert sleep structure to normal. He came back four
months later. He had no residual daytime sleepiness. He used
CPAP regularly, but he had to initiate paroxetine again.
Polysomnographic study with fixed CPAP at 12cm H
demonstrated a decrease in REM duration to 57.5 minutes
with a REM latency of 38.5 minutes. Apnoea/hypopnea index
was 0.2, and lowest SaO
Author comment: "We enquired about possible additional
factors contributing to that abnormal REM rebound and
concluded that withdrawal of paroxetine could be involved."
Lo Bue A, et al. Extreme REM rebound during continuous positive airway
pressure titration for obstructive sleep apnea in a depressed patient. Case Reports
in Medicine 2014: 292181, Jan 2014. Available from: URL: http://
doi.org/10.1155/2014/292181 - Italy
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