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Evaluation of the central sleep apnea in asymptomatic children with Chiari 1 malformation: an open question
Marco Zaffanello1, Francesco Sala2, Luca Sacchetto3
1Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy. marco.zaffanello@univr.it.
Insights
The Scholle scoring system may better assess central sleep apneas in children with Chiari 1 malformation, aiding closer follow-up for asymptomatic cases. Further research is necessary to confirm its utility.
Area of Science:
- Neurology
- Pediatrics
- Sleep Medicine
Background:
- Chiari malformation Type I is a common pediatric condition involving cerebellar tonsil herniation into the foramen magnum.
- This can cause intermittent intracranial hypertension and, in symptomatic children, central sleep apneas detected via polysomnography.
- Central sleep apnea severity varies with age, with indices >1/h abnormal and >5/h pathological.
Observation:
- Three pediatric patients with Chiari malformation Type I underwent polysomnography.
- Central sleep apneas were evaluated using two scoring systems: Scholle (2011) and the American Academy of Sleep Medicine (2012).
Findings:
- The study compared the efficacy of two distinct scoring systems for central sleep apneas in pediatric patients with Chiari malformation Type I.
- Preliminary findings suggest potential differences in how the Scholle and AASM systems quantify central sleep apneas in this population.
Implications:
- The Scholle scoring system may offer advantages for monitoring asymptomatic children with Chiari 1 malformation, facilitating closer clinical follow-up.
- Additional research is required to validate these findings and establish the Scholle system's role in managing pediatric Chiari malformation patients.
Introduction:
Type I is the most common Chiari malformation in children. In this condition, the lower part of the cerebellum, but not the brain stem, extends into the foramen magnum at the base of the skull leading to intermittent brain hypertension. In symptomatic children, central sleep apneas are shown in polysomnography evaluation. A central apnea index of 1/h or more is considered abnormal, but >5/h is clearly considered pathological. Therefore, central sleep apnea evaluation in pediatric age may show great age-related variability.
Method And Subjects:
We present three patients who were assessed by polysomnography with two different scores for central sleep apneas published in the literature: the method by Scholle (2011) and the American Academy of Sleep Medicine scoring system (2012).
Conclusions:
We speculated that the Scholle scoring system can be more helpful in assessing children with asymptomatic Chiari 1 malformation for a closer follow-up. More studies are needed.