Management of Sleep Apnea in Children with Chiari I Malformation: A Retrospective Study

Abstract

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 (OSA), central (CSA), and mixed sleep apnea in a cohort of pediatric CM-1 patients treated at our institution. We also assessed AHI 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 from our database of 465 CM-1 patients. Sleep apnea diagnosis was based on the sleep physician’s overall interpretation of the polysomnography. Symptomatology pre- and post-surgery was analyzed. Results: Of the 75 CM-1 patients that underwent polysomnography, 23 were diagnosed with sleep apnea. 16 had OSA, 6 had CSA, and 1 had mixed apnea. 12 OSA patients received ENT intervention. 8 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 our results, sleep apnea in CM-1 patients may be obstructive, central, or mixed and is likely multifactorial. A multi-disciplinary approach to 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.