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Obstructive sleep apnea syndrome with bilateral papilledema and vision loss in a 3-year-old child

Anthony G Quinn1, Pieter Gouws, Sophie Headland

  • 1West of England Eye Unit, Royal Devon and Exeter Hospital, Exeter, United Kingdom. anthony.quinn@rdehc-tr.swest.nhs.uk

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|February 22, 2008
PubMed

Insights

Obstructive sleep apnea can cause dangerous intracranial pressure in children, even without craniosynostosis. This condition can lead to papilledema and vision loss, highlighting the need for prompt diagnosis and management.

Area of Science:

  • Pediatric Neurology
  • Ophthalmology
  • Sleep Medicine

Background:

  • Obstructive sleep apnea (OSA) is increasingly recognized in children.
  • Elevated intracranial pressure (ICP) is a serious neurological condition.
  • Papilledema and vision loss are critical signs of increased ICP.

Observation:

  • A 3-year-old child presented with bilateral papilledema and vision loss.
  • The child had a diagnosis of obstructive sleep apnea.
  • Initial lumbar puncture showed normal cerebrospinal fluid (CSF) opening pressure.

Findings:

  • Continuous CSF pressure monitoring during sleep revealed intermittent ICP elevations.
  • These ICP spikes correlated with increased airway resistance during sleep.
  • This association was observed in the absence of craniosynostosis.

Implications:

  • Obstructive sleep apnea may be an under-recognized cause of elevated intracranial pressure in children.
  • This finding expands the known associations of OSA with neurological complications.
  • Early recognition and management of OSA are crucial to prevent vision loss and neurological damage.

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