# Investigation of Possible Cardiac Manifestations of Dysautonomia in a Patient With Acquired Ondine’s Curse Syndrome: A Rare Clinical Case Report

## TL;DR

This case report describes a patient with acquired Ondine's curse syndrome following a brainstem stroke, who exhibited bradycardia during sleep apnea episodes.

## Contribution

The report highlights a rare clinical case linking dysautonomia from brainstem stroke to possible cardiac manifestations.

## Key findings

- The patient experienced episodes of sinus bradycardia during sleep and prolonged apnea.
- The link between bradycardia and dysautonomia remains unclear due to lack of clear evidence.
- Further investigation was deferred due to insufficient clinical indications for treatment.

## Abstract

Ondine's curse, also known as central alveolar hypoventilation syndrome, is a very rare condition characterized by failure of breathing mechanisms during sleep. The most usual cause of acquired Ondine's curse syndrome is a stroke of the brainstem, causing dysautonomia, which is primarily manifested by sleep apnea, but can also cause cardiac rhythm disturbance. We present the case of an 81-year-old female with a history of a brainstem and cerebellum ischemic stroke one month ago, which resulted in acquired Ondine's curse syndrome. The patient had been sleeping with respiratory support at a rehabilitation center and was transferred to our hospital in order to investigate possible arrhythmias due to the concurrent dysautonomia. The patient was hospitalized and continuously monitored at our hospital for a total of 72 hours, during which many episodes of sinus bradycardia were monitored. These episodes occurred only when the patient was asleep and in tandem with prolonged sleep apnea episodes. It is unclear whether bradycardia was within the normal circadian cardiac rhythm pattern or was a manifestation of dysautonomia. Arrhythmiologic (electophysiology) consultation deferred further treatment or monitoring measures due to a lack of clear indications.