Abstract
Ticagrelor is an oral, third-generation reversible P2Y12 receptor antagonist used in the treatment of patients with atherosclerotic cardiovascular disease. Dyspnea is a well-recognized side effect of ticagrelor, typically occurring within hours to days after initiation. In most cases, the dyspnea is mild and resolves spontaneously without intervention. However, dyspnea can be significant and intolerable in some patients necessitating discontinuation of ticagrelor. Less commonly recognized is the association of ticagrelor with central sleep apnea. Here, we present a case of a patient who developed dyspnea shortly after starting ticagrelor but also exhibited evidence of central sleep apnea, both of which markedly improved upon discontinuation of the drug. The exact pathophysiologic mechanism underlying ticagrelor-associated dyspnea and central sleep apnea remains unclear. However, one hypothesis suggests that stimulation of pulmonary vagal C-fibers leads to increased levels of extracellular adenosine, which may heighten chemosensitivity to hypercapnia and thus contribute to these respiratory effects.
Keywords
Dyspnea, Central sleep apnea, Hypopnea, Cheyne-stokes respiration, Ticagrelor