0984 Near Drowning: A Complex Case of Somnolence and Weakness

Abstract Introduction Narcolepsy is a disorder of sleep characterized by pathologic daytime sleepiness classically divided into two major subtypes – those with or without cataplexy. The underlying pathophysiologic mechanism thought to be related hypocretin/orexin; pathologically low levels hypocretin characterize narcolepsy We present complex case weakness in patient evaluated for narcolepsy. Report case(s) A 38 year-old male BMI 33 presented decade and sudden debilitating attacks muscle weakness. He underwent level III home testing revealing respiratory event index 5.3/h. After an unsuccessful trial mandibular advancement, he was started on positive airways pressure (PAP) but continued experience episodes concerning cataplexy including sensation legs feeling stiff falling stress. also described while swimming inability stand stabilize, prompting evaluation Sleep diary showed average nightly 6.5 hours, latency, refreshing napping. PSG using CPAP 8 cm H2O showing AHI 0.2/h, time 6.2 latency 5.5 minutes REM evidence atonia. MSLT mean 7.6 3/5 onset periods. Therapeutic trials venlafaxine pitolisant did not result symptomatic improvement, further genetic HLA DQB-1 negative. CSF measurement normal (329 pg/mL, reference > 200 pg/mL). These effectively ruled out as the cause his PAP therapy, venlafaxine, modafinil mg hypersomnia/narcolepsy good response. Conclusion highlighting utility confirmatory acute accompanying stress strong emotion, particularly dangerous events during swimming. Due lack therapeutic response despite MSLT, were pursued. This highlights limitations history alone diagnosis cataplexy, advanced testing. Support (if any)