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Images: Polysomnographic artifacts in a child with congenital central hypoventilation syndrome

Lehna Pino-Diaz1, Roberta M Leu1, Ajay S Kasi1

  • 1Division of Pediatric Pulmonology and Sleep Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia.

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine
|September 24, 2020
PubMed

Insights

Diaphragm pacing (DP) supports children with congenital central hypoventilation syndrome. Polysomnography helps optimize DP settings and identify artifacts during sleep studies for better respiratory support.

Area of Science:

  • Pediatric Pulmonology
  • Biomedical Engineering
  • Sleep Medicine

Background:

  • Congenital central hypoventilation syndrome (CCHS) necessitates ventilatory support.
  • Diaphragm pacing (DP) utilizes the patient's diaphragm as a respiratory pump.
  • DP is a key treatment for CCHS, particularly during sleep.

Observation:

  • A 14-year-old boy with CCHS using DP with an uncapped tracheostomy during sleep was studied.
  • Polysomnography revealed regular, multichannel artifacts coinciding with DP inspiratory impulses across various sleep stages.
  • Artifacts were noted in leg movement, snore, and electrocardiogram channels.

Findings:

  • DP impulses create characteristic multichannel artifacts during polysomnography in CCHS patients.
  • The patient was initially hyperventilated on home DP settings.
  • Polysomnography allowed for adjustment of DP settings to achieve optimal oxygenation and ventilation.

Implications:

  • Clinicians interpreting polysomnograms in patients using DP require awareness of these specific artifacts.
  • Polysomnography is crucial for titrating DP settings to ensure adequate gas exchange in CCHS.
  • This case underscores the importance of polysomnography for optimizing DP therapy in pediatric CCHS patients.

Keywords:
CCHSartifactcongenital central hypoventilation syndromediaphragm pacingpolysomnogram

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