Central Sleep Apnea - a Rare Cause for Acute Respiratory Insufficiency in Children. Case Report

Area of Science:

• Pediatric Neurology
• Pulmonology
• Neurosurgery

Background:

• Central sleep apnea (CSA) is uncommon in children, with limited data available for this demographic.
• This case highlights CSA in a pediatric patient with complex medical history including myelomeningocele, hydrocephalus, and flaccid paralysis.

Purpose of the Study:

• To present a pediatric case of central sleep apnea secondary to brainstem compression.
• To illustrate the diagnostic and therapeutic challenges in managing CSA in a child with significant comorbidities.

Main Methods:

• Clinical case presentation of a five-year-old girl with respiratory distress and suspected sleep apnea.
• Diagnostic workup included physical examination, laboratory tests, thoracic radiography, and cerebral CT scan.
• Treatment involved medical management for aspiration pneumonia followed by neurosurgical intervention for brainstem compression.

Main Results:

• The patient initially presented with aspiration pneumonia and acute respiratory failure, which resolved with medical treatment.
• Nocturnal respiratory disturbances, including central sleep apnea and hypercapnic respiratory acidosis, persisted post-infection.
• Cerebral CT revealed fourth ventricle compression of the brainstem, leading to successful neurosurgical intervention and remission of apnea.

Conclusions:

• Brainstem compression due to isolated fourth ventricle can cause central sleep apnea in children.
• Prompt diagnosis and targeted neurosurgical intervention are crucial for managing CSA secondary to structural brain abnormalities.
• This case underscores the importance of considering central causes of sleep apnea in pediatric patients with neurological comorbidities.