SESSION TYPE: Miscellaneous Cases II
PRESENTED ON: Tuesday, October 23, 2012 at 11:15 AM - 12:30 PM
INTRODUCTION: Catathrenia, derived from the Greek word (kata-like, threnia-to lament), is a sleep-related respiratory condition described as high pitched, monotonous groaning, moaning, respiratory dysrhythmia with bradypnea and vocalisation or inarticulate expiratory phonation. Clearly a rare disorder, its actual incidence and prevalence are unknown with a limited number of cases presented in the literature.
CASE PRESENTATION: A fourteen year old boy with a history of bronchial asthma presented for evaluation of snoring and witnessed apneic episodes. The mother described the snoring as “funny noises” during sleep after apparent breath holding which awakens him at night. There was no prior history of sleep-related breathing disorder or parasomnia. Physical exam revealed normal vital signs with BMI at 85th percentile for age. Oropharyngeal exam revealed a Mallampati class I airway and tonsils grade 2+. Overnight polysomnogram (PSG) revealed monotonous groaning sounds (Video / Image 1) heard during non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep which occurred in clusters and ended with a grunt or an arousal. Oxyhemoglobin saturation levels at or above 95% were noted throughout the study. Although the PSG findings closely resembled central apneas, careful inspection of the PSG waveforms along with audio and video recordings revealed the protracted expiration with monotonous groaning preceded by deep inspiration, which is diagnostic of catathrenia. Patient is currently using nasal CPAP resulting in improvement in groaning episodes.
DISCUSSION: The occurrence during sleep of bradypnea with prolonged expiration and sound generation continues to be an enigma. Although multiple mechanisms have been proposed, the precise pathophysiology of catathrenia remains elusive, the response to treatment ranging from medications to continuous positive airway pressure (CPAP) remains variable, and the long term prognosis remains unexplained. Central sleep apnea may be confused with these bradypneic episodes but preceding deep inspiration and subsequent vocalizations in addition to the absence of oxygen desaturations differentiate these events from true central apneas.
CONCLUSIONS: It is imperative not to confuse catathrenia with other respiratory and nonrespiratory disturbances during sleep for the important and obvious consequences on treatment and prognosis.
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DISCLOSURE: The following authors have nothing to disclose: Yong Han Kim, Paramjeet Atwal, Michael Weinstein, Mary Cataletto
No Product/Research Disclosure InformationWinthrop University Hospital - Winthrop Sleep Disorders Center, Garden City, NY