Trauma and syncope-evidence for further sleep study? A case report

Abstract

We report on an 83-year-old male with traumatic brain injury after syncope with a fall in the morning. He had a history of seizures, coronary artery disease and paroxysmal atrial fibrillation (AF). No medical cause for seizures and syncope was determined. During rehabilitation, the patient still complained of seizures, and also reported sleepiness and snoring. Sleep apnea diagnostics revealed obstructive sleep apnea (SA) with an apnea-hypopnoea index of 35/h, and sudden onset of tachycardia with variations of heart rate based on paroxysmal atrial fibrillation. Additional tests showed nocturnal AF which spontaneously converted to sinus rhythm mid-morning with an arrest of 5 s (sick sinus syndrome) and seizures. A DDD-pacer was implanted and no further seizures occurred. SA therapy with nasal continuous positive airway pressure was refused by the patient. Our findings suggests that screening for SA may offer the possibility to reveal causes of syncope and may introduce additional therapeutic options as arrhythmia and SA often occur together which in turn might be responsible for trauma due to syncope episodes.

Keywords: Sleep apnea; Syncope; Atrial fibrillation; Trauma

Core tip: Arrhythmias and sleep apnea should be considered as relevant factors resulting in syncope and trauma in the elderly. This case report applies screening for sleep apnea to detect arrhythmia as a common cause of syncope. Screening for sleep apnea may offer the possibility of additional therapeutic options and diagnostic in trauma and syncope after performing standard diagnostics.