A case of central sleep apnea strictly dependent upon REM-sleep

Central sleep apnea (CSA) is characterized by the inability to generate regular breathing patterns as a result of the loss of metabolic drive and failure of respiratory muscle control. We present the case of a 54-year-old woman with a severe CSA strictly dependent upon REM-sleep. Extensive diagnostic workup excluded typical underlying causes and serological analysis revealed acute borreliosis infection. The severity of sleep apnea decreased after repeated polysomnographic studies without a specific therapy. CSA is usually associated with non-REM stages of slow-wave-sleep. This report illustrates the clinical presentation and diagnostic implications of an unusual case of a CSA strictly associated with REM-sleep. Anecdotally reports of severe respiratory failure in borreliosis indicate the potential of this infection to destabilize breathing control but the precise impact of the infection remains controversial. In our case, a relevant neuroborreliosis was not proven, since there were no other neurologic impairments and the patient refused studies of liquor fluid.