• Pei Xue, Junying Zhou, Fei Lei, Lu Tan, Xiao Li, and Xiangdong Tang.
• Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
• Medicine (Baltimore). 2020 Mar 1; 99 (12): e18949.

IntroductionDreaminess is one of the common symptoms of sleep disorders and often leads to complaint of poor sleep quality and morning fatigue. Literatures on the relationship between obstructive sleep apnea (OSA) and dreams have been reported with contradictory results. In this case report, we identified a moderate OSA related dreaminess that was successfully treated by continuous positive airway pressure (CPAP).Patient ConcernsWe present a case of a 47-year-old woman who was bothered by all-night dreaminess for over 20 years.DiagnosisAn overnight polysomnography (PSG) examination showed the apnea-hypopnea index (AHI) was 21.7 events/hour and the rapid eye movement (REM)-AHI was 46.3 events/hour. The patient was diagnosed with moderate OSA.InterventionsThe patient received auto CPAP therapy.OutcomesThe symptoms of dreaminess and daytime functioning significantly improved after CPAP treatment. During the 4-month follow up, 3 CPAP titrations showed that OSA events and OSA related REM interruption almost disappeared. On the night of PSG diagnosis, only 1 non-rapid eye movement sleep 3 (N3) episode occurred before the first REM episode. Nevertheless, N3 episodes were observed before the majority of REM episodes on all three nights of CPAP titration.ConclusionThis case suggests that specific REM related OSA could be the main reason for dreaminess symptoms and could be successfully treated by CPAP. The identification of OSA, especially for mild-moderate OSA, has not received enough attention in the management of complaints of dissatisfactory sleep issues. We believe this case has educational value in clinical practice.

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