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Upper airway obstruction and raised intracranial pressure in children with craniosynostosis
S Gonsalez1, R Hayward, B Jones
1Portex Anaesthesia, Intensive Therapy & Respiratory Medicine Unit, Institute of Child Health, London, UK.
Insights
Children with syndromic craniosynostosis often have upper airway obstruction (UAO) and raised intracranial pressure (ICP). UAO severity correlated with higher ICP during sleep in these patients.
Area of Science:
- Pediatric Neurosurgery
- Sleep Medicine
- Craniofacial Surgery
Background:
- Craniosynostosis in children can lead to elevated intracranial pressure (ICP) and upper airway obstruction (UAO).
- The interplay between UAO and ICP during sleep in pediatric craniosynostosis is not well understood.
Purpose of the Study:
- To compare ICP levels during sleep in children with syndromic craniosynostosis (associated with UAO) versus controls with isolated unicoronal synostosis (normal airways).
- To investigate the relationship between UAO and ICP during sleep in pediatric craniosynostosis.
Main Methods:
- Polygraphic cardiorespiratory sleep studies with continuous ICP monitoring were conducted in 13 children with syndromic craniosynostosis and 7 controls.
- Patients were studied during unsedated sleep.
Main Results:
- 11/13 syndromic patients had UAO, with 8/13 experiencing obstructive sleep apnea; no controls had UAO.
- 10/13 syndromic patients had elevated ICP, compared to 3/7 controls.
- ICP was higher during active sleep than quiet sleep in both groups.
- A significant correlation was found between UAO severity and increased ICP during active sleep.
Conclusions:
- Obstructive respiratory issues and intracranial hypertension are common in children with syndromic craniosynostosis.
- Further research is needed to explore a potential causal link between UAO and elevated ICP in this population.
Abstract:
In children with craniosynostosis, raised intracranial pressure (ICP) and upper airway obstruction (UAO) are both common features. However, potential interactions between UAO and ICP during sleep are poorly understood. The aim of the present study was to compare the levels of ICP during sleep between a group of patients with syndromic craniosynostosis (with facial involvement and consequent UAO) and a group of control patients with isolated unicoronal synostosis (with no facial involvement and normal upper airways). Polygraphic cardiorespiratory sleep studies with continuous monitoring of ICP were performed during unsedated sleep in 13 children with syndromic craniosynostosis and 7 control patients with isolated unicoronal synostosis only. In the syndromic group, UAO was present in 11 out of 13 patients, with 8 out of 13 having frank obstructive sleep apnoea. In contrast, none of the control patients showed signs of UAO during sleep. There was no evidence of central apnoeas in any of the patients studied. Clinical histories taken from parents tended to underestimate the severity of the respiratory problems. Elevated ICP was seen in 10 of the 13 syndromic patients, with borderline raised ICP in the remaining three cases. In contrast, raised ICP was seen in only 3 of the 7 control patients, with borderline raised levels in 2 of the 7. For both patient groups, ICP was higher during active sleep compared to quiet sleep. Multiple regression analysis showed that ICP during active sleep was dependent upon disease severity (unicoronal/ multiple synostosis) and to the baseline ICP level during quiet sleep. Both raised ICP and airway obstruction were more apparent during active sleep. There was a significant correlation between severity of UAO and increased ICP in active sleep. We conclude that obstructive respiratory problems are frequent in the syndromic patients, and can be severe in a large proportion of cases; intracranial hypertension is also frequent in this group. Further studies are required to investigate the possibility of a causal relationship between upper airway obstruction and raised intracranial pressure.