1220 Veteran with Sleep Eating, Post-traumatic Stress Disorder and Severe Obstructive Sleep Apnea

Abstract

Introduction: Obesity is a risk factor for obstructive sleep apnea (OSA), and typically results from caloric intake in excess of energy expenditure. Sleep-related eating disorder, a parasomnia associated with binge eating during the sleep period, typically with minimal recollection or conscious control, is also associated with weight gain. In some instances, sleep eating episodes may be induced by arousals related to untreated OSA that occur during sleep. Report of case: A 41-year old male veteran with a medical history of obesity, post-traumatic stress disorder, alcohol use disorder in remission, vitamin D deficiency, hypothyroidism and chronic pain, who was prescribed gabapentin, aripiprazole, prazosin, escitalopram, levothyroxine, cholecalciferol, meloxicam, methocarbamol and nicotine supplements for these difficulties, presented with complaints of snoring, nightly sleep eating behaviors, excessive daytime sleepiness, fatigue, non-restorative sleep and 40 pounds weight gain over 8 months. The patient's main concern was sleep eating which had been occurring nightly, for at least two years. Behaviors were characterized by getting up, going to the kitchen and eating whatever was easily available, without preferences for certain types of foods. The patient did not have recollection for these events in the morning. Nocturnal polysomnography demonstrated severe OSA with an overall apnea/hypopnea index (AHI) of 108.3/hour. Titration of positive airway pressure (PAP) was tolerated well, and the patient was prescribed AutoCPAP 8-14 cmH2O. There was no sleep eating behavior or other parasomnia noted during the polysomnogram. Conclusion: This case highlights the possible associations between sleep eating behaviors and sleep disordered breathing. When these sleep disorders co-occur, it is often difficult to identify which disorder is causal. Longitudinal assessment is required to clarify the effects of positive airway pressure therapy on sleep eating, and whether such treatment has a direct impact on body habitus.