Impact of sleep‐disordered breathing on the management of children with Chiari malformation type I

Abstract

Objectives: Children with Chiari malformation type I (CM-I) have an increased risk of sleep apnea. The aim of the study was to describe the management of CM-I patients in relation to symptoms, magnetic resonance imaging (MRI) findings and sleep apnea syndrome (SAS). Methods: We performed a retrospective analysis of clinical charts of all 57 CM-I patients seen between September 2013 and April 2017. Results: A total of 45 patients had isolated CM-I or associated co-morbidity (CM-Iia), 5 had craniosynostosis (CM-Ics), and 7 a polymalformative syndrome (CM-Ipm). The prevalence of SAS, defined as an apnea-hypopnea index >1 event/h, was high in CM-I ranging from 50% to 80% according to the CM-I group. The prevalence of central sleep apnea (CSA) was low, with 5 (9%) patients having CSA and only 3 patients with CM-Iia having isolated CSA. A total of 17 patients (30%) had foramen magnum decompression (FMD). Neither positive symptoms of CM-I nor MRI findings alone, nor both combined were good indicators for FMD. No correlation was observed between the cerebellar tonsil descent and SAS in CM-I. But all 5 patients with CSA had a FMD. The combination of MRI findings and/or symptoms of CM-I together with moderate-to-severe SAS best discriminated patients who needed a FMD. Conclusion: Our findings highlight the importance of a combined evaluation of symptoms, MRI and polygraphy results in the management of CM-I patients.

Malignant mesothelioma tumours: molecular pathogenesis, diagnosis, and therapies accompanying clinical studies

“…In many cases, the latter is a pre-event -terminal. In other cases, the patient is asymptomatic, but an anomaly was identified in an imaging study conducted for another cause ( 64 ). As a result of early diagnosis, asymptomatic individuals tend to have a higher life expectancy.…”

Pediatric Sleep Respiratory Disorders: A Narrative Review of Epidemiology and Risk Factors

“…CM1 can also be associated with other comorbidities or complex disorders, and in a very recent retrospective study on 57 heterogeneous children with CM1 (45 children with isolated CM1 or with a comorbid condition, 5 children with CM1 associated with craniosynostosis, 7 children with CM1 and a polymalformative syndrome), the prevalence of SDB was very high, ranging from 50% to 80%, based on the different characteristics of the patients enrolled, notably with a low prevalence of CSA (9%). This study highlighted the importance of a combined evaluation of symptoms, MRI, and sleep studies in the management of patients with CM1 [ 87 ].…”