A case of Cheyne-Stokes breathing emerging in a patient with atrial fibrillation and an implanted hypoglossal nerve stimulator.

Treatment emergent central sleep apnea (TECSA) can occur with positive airway pressure (PAP) therapy, mandibular advancement devices, and now recent cases with hypoglossal nerve stimulator (HNS) therapy during treatment for obstructive sleep apnea (OSA). There have been few published reports of Cheyne-Stokes breathing (CSB) emerging after implantation of an HNS. We present a case of a 76-year-old male with chronic atrial fibrillation and OSA who developed significant CSB after implantation of an HNS device. As popularity increases for alternative treatments of OSA, there should be close monitoring for emergence of CSB, especially in those who may have a propensity for high loop gain abnormalities contributing to central sleep apneas, such as patients with chronic atrial fibrillation. Further research is needed on CSA in patients with HNS implantation and atrial fibrillation, the prevalence of TECSA in the growing HNS therapy population, and the development of future management strategies. CITATION: Hong H, Oster J, Grover A, Ismail K. A case of Cheyne-Stokes breathing emerging in a patient with atrial fibrillation and an implanted hypoglossal nerve stimulator. J Clin Sleep Med. 2021;17(8):1731-1735.