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Published on: December 6, 2016
Transient Central Sleep Apnea Runs Triggered by Disorder of Arousal in a Child
Lourdes M DelRosso1,2, Kenneth Martin2, Michelle Marcos2
1University of California, San Francisco, California.
Insights
A child
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Respiratory Medicine
Background:
- Disorders of arousal (parasomnias) are common in children.
- Central sleep apnea (CSA) is a sleep-related breathing disorder.
- The relationship between parasomnias and CSA is not well understood.
Observation:
- A 5-year-old girl experienced frequent nocturnal episodes of confusional arousals, sleep terrors, and sleepwalking.
- These episodes, occurring during slow-wave sleep, were followed by periodic breathing with central events and oxyhemoglobin desaturation.
- Clonazepam initially resolved parasomnias but caused paradoxical behavioral issues; sleep extension and melatonin were effective in reducing episode frequency and intensity.
Findings:
- This case presents a potential link between parasomnia and central sleep apnea.
- Central sleep apnea sequences were observed to be triggered by parasomnia events.
- The severity of central events and desaturation decreased progressively within each run.
Implications:
- This suggests a possible new classification of "complex parasomnia" involving central sleep apnea.
- Further research is needed to confirm this association in other pediatric cases.
- Understanding this link may lead to novel treatment strategies for complex sleep disorders in children.
Abstract:
We report the case of a 5-year-old girl with frequent nocturnal episodes of disorder of arousal (confusional arousals, sleep terrors, and sleep walking), occurring at the end of periods of slow wave sleep, followed by return to sleep accompanied by the occurrence of periodic breathing with a run of approximately 10 to 20 central events. The duration of the central events and oxyhemoglobin desaturation were both maximum at the beginning of each run and became progressively less prominent with the development of the sequences. Night episodes disappeared with bedtime clonazepam but behavioral problems occurred as a paradoxical response; thus, clonazepam was stopped. Sleep extension and melatonin were then started, which were followed by a reduction of night episode frequency and intensity. This observation appears to be the first report of central sleep apnea sequences triggered by parasomnia and, if confirmed by additional reports, it might be considered to be a possible new classification of "complex parasomnia."
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