Type one chiari malformation as a cause of central sleep apnea and hypoventilation in children.
Sleep Med
; 116: 32-40, 2024 Apr.
Article
em En
| MEDLINE
| ID: mdl-38417306
ABSTRACT
OBJECTIVES:
Chiari type 1 malformation (CM1) may occasionally lead to central sleep apnea (CSA). We studied, in a large clinical cohort of pediatric CM1 patients, the effect of CM1 on breathing during sleep.METHODS:
This is a retrospective single pediatric pulmonology center study with a systematic evaluation of pediatric CM1 patients under age 18 with polysomnography (PSG) during 2008-2020. Children with syndromes were excluded. All patients had undergone head and spine magnetic resonance imaging.RESULTS:
We included 104 children with CM1 with a median age of 7 (interquartile range (IQR) 5-13) years. The median extent of tonsillar descent (TD) was 13 (IQR 10-18) mm. Syringomyelia was present in 19 children (18%). Of all children, 53 (51%) had normal PSG, 35 (34%) showed periodic breathing or central apnea and hypopnea index ≥5 h-1, and 16 (15%) displayed features of compensated central hypoventilation and end-tidal or transcutaneous carbon dioxide 99th percentile level above 50 mmHg. TD had the best predictive value for central breathing disorders. In a linear model, both age (61%) and TD (39%) predicted median breathing frequency (R = 0.33, p < 0.001).CONCLUSIONS:
Although severe CSA is a rare complication of brainstem compression in pediatric patients with CM1, short arousal-triggered episodes of periodic breathing and mild compensated central hypoventilation are common. TD shows the best but still poor prediction of the presence of a central breathing disorder. This highlights the use of PSG in patient evaluation. Posterior fossa decompression surgery effectively treats central breathing disorders.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Malformação de Arnold-Chiari
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Transtornos Respiratórios
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Apneia do Sono Tipo Central
Limite:
Adolescent
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Child
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Child, preschool
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Humans
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article