1135 Teenager with a noisy breathing in sleep - A rare case of Catathrenia

Abstract

Introduction: Catathrenia is a sleep-disordered breathing pattern characterized as expiratory groaning or moaning during sleep. It is a rare disorder which is often confused with stridor, sleep related laryngospasm and sleep talking. Current literature, includes reports primarily in adults with onset in young adulthood. We report a case of polysomnography (PSG) video documented catathrenia in a 13-yearold male. Report of Case: 13-year-old male with ADHD presented to our sleep clinic with complaints of loud breathing and nightly snoring. He had a consistent sleep/wake schedule and average sleep duration of 8?9 hrs. His mother reported restless sleep and moaning associated with long pauses. He denied excessive day time sleepiness. His review of symptoms was unremarkable. Physical examination was notable for BMI-24, 2+ tonsillar size and Mallampati score of II. Epworth sleepiness score was 4/24. Video PSG was performed which resulted in mild overall disruption of the sleep architecture with 91.0% sleep efficiency. Sleep onset latency and REM sleep latency were normal at 11.5 and 95.5 minutes respectively. The total arousal index was elevated at 12.5/hour. N1, N2 and N3 sleep were 11.9%, 54.4%,14.4% respectively and REM sleep was 19.4%. The total Apnea-Hypopnea Index (AHI) was 8.3 with obstructive AHI of 2.7 and central apnea index of 5.58. Frequent expiratory moaning was associated with central apneas, ranging from 13?17 sec in duration, without desaturations. It occurred equally in both NREM and REM sleep. Furthermore, the prolonged expiration was preceded by arousals. Brain MRI showed no significant abnormality. Hence, he was diagnosed with catathrenia. Conclusion: Catathrenia, although classified in ICSD-3 under sleep related breathing disorder, still remains underrecognized in a pediatric age group. Without the video the diagnosis can easily be missed or mistakenly recognized as central sleep apnea. PSG video monitoring therefore remains essential for establishing a diagnosis and guiding treatment.