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Vol. 40. Issue 6.
Pages 283-286 (June 2004)
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Vol. 40. Issue 6.
Pages 283-286 (June 2004)
Case Reports
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Acute Confusional Syndrome Associated With Obstructive Sleep Apnea Aggravated by Acidosis Secondary to Oral Acetazolamide Treatment
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E. Miguela, R. Güella, A. Antóna, J.A. Montielb, M. Mayosa,
Corresponding author
mmayos@hsp.santpau.es

Correspondence: Dra. M. Mayos. Departamento de Neumología. Hospital de la Santa Creu i de Sant Pau. Sant Antoni M. Claret, 167. 08025 Barcelona. España
a Departamento de Neumología, Hospital de la Santa Creu i de Sant Pau, Barcelona. Spain
b Departamento de Medicina Interna, Hospital de la Santa Creu i de Sant Pau, Barcelona, Spain
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Acute confusional syndrome, or delirium, is a transitory mental state characterized by the fluctuating alteration of awareness and attention levels. We present the case of a patient with acute confusional syndrome associated with obstructive sleep apnea syndrome (OSAS) aggravated by metabolic acidosis induced by oral acetazolamide treatment.

A 70-year-old man with no history of neurological disease was referred with a clinical picture consistent with acute confusional syndrome presenting between midnight and dawn. During the admission examination infectious, toxic, and neurologic causes, or those related to metabolic or heart disease were ruled out. Arterial blood gases measured during one of the nighttime episodes of acute confusional syndrome showed mild hypoxia and hypercapnia with mixed acidosis. Signs and symptoms suggestive of OSAS had been developing over the months prior to admission, with snoring, sleep apnea, and moderate daytime drowsiness. Polysomnography demonstrated severe OSAS with an apnea-hypopnea index of 38. Mean arterial oxygen saturation was 83%; time oxygen saturation remained below 90% was 44%. The attending physician ordered the withdrawal of oral acetazolamide, which was considered the cause of the metabolic component of acidosis. Treatment with continuous positive airway pressure was initiated at 9 cm H2O after a titration polysomnographic study. The patient continued to improve.

OSAS, for which very effective treatment is available, should be included among diseases that may trigger acute confusional syndrome.

Key words:
Acute confusional syndrome
Delirium
Obstructive sleep apnea syndrome
Metabolic acidosis
Acetazolamide

El síndrome confusional agudo o delirium es un trastorno transitorio del estado mental caracterizado por la alteración fluctuante del nivel de conciencia y atención. Presentamos el caso de un paciente con síndrome confusional agudo asociado a síndrome apnea-hipopnea obstructiva del sueño (SA-HOS), agravado por una acidosis metabólica secundaria al tratamiento con acezatolamida.

Se trataba de un varón de 70 años de edad, sin antecedentes de enfermedad neurológica previa, remitido por un cuadro confusional agudo de inicio en la madrugada. Durante el ingreso se descartaron causas de origen infeccioso, tóxico, neurológico o secundarias a enfermedad metabólica o cardíaca. Los gases arteriales obtenidos en la madrugada durante uno de los episodios de síndrome confusional agudo mostraron una ligera hipoxia e hipercapnia con acidosis de tipo mixto. El paciente había presentado en los meses previos al ingreso síntomas indicativos de SAHOS (ronquido, pausas respiratorias durante el sueño y somnolencia diurna moderada). Se efectuó una polisomnografía diagnóstica que puso de manifiesto un SAHOS de carácter grave. El índice de ap-nea-hipopnea/h era de 38, la saturación de oxígeno media del 83% y el tiempo de saturación de oxígeno por debajo del 90%, del 44%. Se retiró la acetazolamida oral, que se consi-deró la causa del componente metabólico de la acidosis, y tras un nuevo estudio polisomnográfico de titulación se inició tratamiento con presión continua en la vía aérea a 9 cmH2O. El paciente siguió un curso clínico favorable.

El SAHOS, entidad con un tratamiento muy eficaz, ha de incluirse entre las enfermedades que pueden precipitar un síndrome confusional agudo.

Palabras clave:
Síndrome confusional agudo
Delirium
Síndrome de apnea-hipopnea obstructiva del sueño
Acidosis metabólica
Acetazolamida
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Copyright © 2004. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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