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Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea

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Chiari I Malformation and Sleep-Disordered Breathing.

Alexandria C Marino¹, Faraz Farzad², John A Jane³

¹Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA; Department of Neurological Surgery, University of Virginia Health Sciences Center, PO Box 800212, Charlottesville, VA 22908, USA.

Neurosurgery Clinics of North America

|November 24, 2022

Summary

Sleep-disordered breathing (SDB) is common in pediatric Chiari I malformation. Surgical decompression may improve SDB in select young or symptomatic patients diagnosed via polysomnography.

Keywords:

Chiari I Pediatric neurosurgery Posterior fossa decompression Sleep apnea

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Area of Science:

Neurology
Pediatric Neurosurgery
Sleep Medicine

Background:

Sleep-disordered breathing (SDB) is a significant symptom in pediatric Chiari I malformation, affecting at least 24% of patients.
Understanding the epidemiology, natural history, pathophysiology, and diagnosis of SDB in this population is crucial.

Purpose of the Study:

To review the current knowledge on SDB in pediatric Chiari I malformation.
To highlight diagnostic criteria and potential treatment outcomes.

Main Methods:

Literature review of case series and epidemiological data.
Analysis of diagnostic approaches including polysomnography.
Evaluation of outcomes following surgical decompression.

Main Results:

SDB is a frequent and important clinical feature in pediatric Chiari I.
Polysomnography is essential for diagnosis, particularly in young, symptomatic, or imaging-abnormal patients.
Surgical decompression shows promise in improving SDB in carefully selected individuals.

Conclusions:

SDB is a key consideration in pediatric Chiari I.
Timely diagnosis with polysomnography is recommended.
Surgical intervention may offer significant benefits for SDB in this patient group.