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A 16-Year-Old Boy with Refractory Epilepsy and Sleep-Disordered Breathing.

Journal of Clinical Sleep Medicine, Vol. 12, No. 7, 2016 The patient is a 16-year-old boy referred for overnight polysomnography due to parental concern for apnea. The parents witnessed breathing pauses of up to 40 seconds that occur during sleep noted only in the past two years. He did not snore and did not appear to struggle to breathe. He slept for 12 hours at night and still was very difficult to wake up in morning. The parents noticed that he was fatigued during the day but did not take naps. His past medical history was significant for refractory generalized epilepsy diagnosed soon after birth requiring multiple antiepileptic medications and vagus nerve stimulator (VNS) placement at age 12 years. He was born at 34 weeks gestational age via normal spontaneous vaginal delivery. His medications included levetiracetam 600 mg twice a day, valproic acid 250 mg three times a day, and gabapentin 300 mg twice a day. Physical exam revealed a non-cooperative, non-verbal child. His weight was at the 20th percentile, height was at the SLEEP MEDICINE PEARLS