title: Severe Central Sleep Apnea Associated With Chronic Baclofen Therapy: A Case Series.
abstract: Baclofen, a gamma-aminobutyric acid-B agonist with muscle-relaxant properties, is widely used in patients with severe spasticity. In animals, baclofen has been shown to decrease respiratory drive. In humans, however, use of baclofen at the standard dose did not significantly impair sleep-disordered breathing in a susceptible population of snorers. Recently, there has been increasing interest in the role of baclofen for the treatment of alcohol dependence. We describe severe central sleep apnea (CSA) in four patients with none of the conditions commonly associated with CSA who were receiving chronic baclofen therapy for alcohol withdrawal. In one patient, baclofen withdrawal was associated with a complete resolution of CSA. Three patients were treated by adaptive servo-ventilation while continuing their treatment with baclofen. Given the increasing number of patients receiving baclofen for alcohol withdrawal treatment, physicians should be aware that these patients might be affected by severe CSA. Future studies are required to determine the mechanisms, prevalence, and treatment modalities of sleep-disordered breathing associated with baclofen usage.
authors.affiliation: Université d'Angers, INSERM 1063, and CHU Angers, Département de Pneumologie, Angers, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Olivier
authors.affiliation: University Grenoble Alpes, HP2, INSERM U1042, and CHU de Grenoble, Laboratoire EFCR, Clinique Universitaire de Physiologie, Grenoble, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Joyeux-Faure
authors.affiliation: Clinique de la Louvière, Laboratoire de sommeil, Lille, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Gentina
authors.affiliation: University Grenoble Alpes, HP2, INSERM U1042, and CHU de Grenoble, Laboratoire EFCR, Clinique Universitaire de Physiologie, Grenoble, France.
authors.forename: Sandrine H
authors.initials: SH
authors.lastname: Launois
authors.affiliation: Service de Physiologie-Explorations Fonctionnelles, DHU FIRE, Hopital Bichat-Claude Bernard, AP-HP, Université Denis Diderot, Paris, France.
authors.forename: Marie Pia
authors.initials: MP
authors.lastname: d'Ortho
authors.affiliation: University Grenoble Alpes, HP2, INSERM U1042, and CHU de Grenoble, Laboratoire EFCR, Clinique Universitaire de Physiologie, Grenoble, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pépin
authors.affiliation: Université d'Angers, INSERM 1063, and CHU Angers, Département de Pneumologie, Angers, France. Electronic address: frgagnadoux@chu-angers.fr.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Gagnadoux
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000188:drug therapy; D001418:Baclofen / Q000009:adverse effects*; D002492:Central Nervous System Depressants / Q000009:adverse effects; D000431:Ethanol / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000009:adverse effects*; D017286:Polysomnography; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D020182:Sleep Apnea, Central / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000209:etiology
chemical_list: D002492:Central Nervous System Depressants; D009125:Muscle Relaxants, Central; D000431:Ethanol; D001418:Baclofen
keywords: alcohol dependence; baclofen; central sleep apnea