Nocturnal apnea in Chiari type I malformation

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Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
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Published on: December 6, 2016

Lonneke A M Aarts1, Michèl A A P Willemsen, Nele L E Vandenbussche

  • 1Department of Pediatrics, Máxima Medical Centre, Veldhoven Postbus 7777, 5500 MB Veldhoven, the Netherlands. Lonneke.Aarts@mmc.nl

European Journal of Pediatrics
|June 7, 2011
PubMed

Insights

Pediatric sleep-disordered breathing can stem from central causes, not just obstructive ones. This case highlights the importance of considering Chiari malformation in diagnosing apnea in children.

Area of Science:

  • Pediatric Neurology
  • Sleep Medicine
  • Neurodevelopmental Disorders

Background:

  • Sleep-disordered breathing (SDB) is a common concern in children, often attributed to upper airway obstruction.
  • Enlarged adenoids are a frequent cause of obstructive sleep apnea (OSA) in pediatric patients.
  • This case examines an unusual presentation of SDB initially suspected as OSA.

Observation:

  • A 4-year-old girl presented with significant sleep-disordered breathing, characterized by prolonged pauses and daytime fatigue.
  • Initial treatment targeting obstructive causes (adenotomy) failed to resolve the symptoms.
  • Polysomnography revealed central apneas, prompting further investigation.

Findings:

  • Central apneas were identified as the primary cause of SDB, despite initial suspicion of obstructive apnea.
  • Cerebral magnetic resonance imaging (MRI) diagnosed a Chiari type I malformation.
  • Polysomnography proved crucial in differentiating central from obstructive apneas.

Implications:

  • This case underscores the necessity of considering central causes of apnea in children, even without overt neurological symptoms.
  • It emphasizes the diagnostic value of polysomnography in distinguishing between central and obstructive sleep apnea.
  • Early identification of underlying neurological conditions like Chiari malformation is vital for effective management of pediatric SDB.
Abstract

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