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Management of Sleep Apnea in Children with Chiari I Malformation: A Retrospective Study
Moira Moore1, William Fuell2, Supriya K Jambhekar3,4
1Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas, USA, memoore@uams.edu.
Insights
Chiari I malformation (CM-1) decompression may improve sleep apnea symptoms. This study found sleep apnea is common in pediatric CM-1 patients, with obstructive sleep apnea (OSA) being most frequent, and decompression surgery offered some benefit.
Area of Science:
- Neurology
- Sleep Medicine
- Pediatric Surgery
Background:
- Chiari I malformation (CM-1) is associated with sleep apnea.
- Decompression surgery for CM-1 may alleviate sleep apnea symptoms.
Purpose of the Study:
- To determine the incidence of obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed sleep apnea in pediatric CM-1 patients.
- To evaluate the effectiveness of Chiari decompression surgery for sleep apnea in this cohort.
- To compare outcomes with Ear, Nose, and Throat (ENT) surgical interventions.
Main Methods:
- Retrospective analysis of 75 pediatric CM-1 patients who underwent polysomnography (PSG).
- Diagnosis of sleep apnea based on PSG interpretation.
- Assessment of patient symptomatology before and after surgical interventions.
Main Results:
- 23 out of 75 CM-1 patients had sleep apnea (16 OSA, 6 CSA, 1 mixed).
- Eight OSA patients improved with ENT intervention; two showed further improvement after Chiari decompression.
- One of six CSA patients improved after Chiari decompression; the mixed apnea patient improved post-decompression.
Conclusions:
- Sleep apnea in pediatric CM-1 patients can be obstructive, central, or mixed and is likely multifactorial.
- A multidisciplinary approach involving neurosurgery, otolaryngology, and sleep medicine is crucial.
- Further prospective studies are needed to fully understand and manage sleep apnea in CM-1.
Introduction:
The literature indicates that decompression of Chiari I malformations (CM-1) may resolve symptoms of sleep apnea. This study aims to identify the incidence of obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed sleep apnea in a cohort of pediatric CM-1 patients treated at our institution. We also assessed apnea-hypopnea index and symptomatology before and after surgery to investigate if Chiari decompression is a viable treatment for sleep apnea in CM-1 patients. Improvement relative to ENT surgical intervention was also considered.
Methods:
We identified 75 patients who underwent polysomnography (PSG) from our database of 465 CM-1 patients. Sleep apnea diagnosis was based on the sleep physician's overall interpretation of the PSG. Symptomatology pre- and post-surgery was analyzed.
Results:
Of the 75 CM-1 patients that underwent PSG, 23 were diagnosed with sleep apnea. Sixteen had OSA, 6 had CSA, and 1 had mixed apnea. Twelve OSA patients received ENT intervention. Eight improved and 2 further improved after Chiari decompression. Of the 4 patients that did not improve, one of those later improved following Chiari decompression. Of the 6 CSA patients, 2 underwent Chiari decompression, but only one improved. The mixed apnea patient underwent several ENT interventions that did not relieve symptoms but improved following Chiari decompression.
Discussion/Conclusions:
Based on our results, sleep apnea in CM-1 patients may be obstructive, central, or mixed and is likely multifactorial. A multidisciplinary approach to the management of these patients is important, including neurosurgery, otolaryngology, and sleep medicine. Future prospective studies will lend further insight into this condition and its management.
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