Nocturnal Frontal Lobe Epilepsy Presenting as Obstructive Type Sleep Apnea

A 20-year-old man presented with sleep apnea. Polysomnography was performed and it revealed nine apneas and two hypopneas. Contrary to typical apnea, however, rhythmic epileptiform discharges appeared at bifrontal area on EEG just before the start of apnoea. Video-EEG monitoring was performed to classify these events, and to evaluate the relationship of apnoea and ictal discharge. Ictal EEG revealed paroxysmal fast activity over the bifrontal area. Ictal SPECT showed hyperperfusion in right frontal area. Given these findings, we concluded that these events were epileptic seizures presenting as obstructive sleep apnea. Antiepileptic medication was initiated, and the events were decreased. This case demonstrates that nocturnal frontal love epilepsy may be the potential cause of obstructive sleep apnea (OSA).