A 10-Year-Old with Frequent, Disruptive, and Unexplained Night Awakenings

A 10-year-old female presented to the sleep clinic for a second opinion about her epilepsy diagnosis. She had been treated with antiepileptic medication but her events persisted. The child would wake up several times every night speaking nonsense words, appear confused to her family, and then go back to sleep. A video of the polysomnography (PSG) showed the patient having two of her typical events. The patient was eventually diagnosed with confusional arousal (CoA) secondary to obstructive sleep apnea (OSA). The nocturnal events resolved after her OSA was treated. This case highlights an atypical clinical presentation for a type of parasomnia like CoA that was misdiagnosed and treated for seizures. It will illustrate OSA and its mechanisms as a potential occasional treatable cause for CoA. It also demonstrates the importance of video-PSG in the work-up of CoA.