Sleep disorder: a possible cause of attention deficit in children and adolescents with Chiari malformation type II

Abstract

-Background: Attention deficit may be related to sleep disorders in Chiari malformation type II (CMII). Our aim is identify sleep disorders and their specific contribution in attention deficit. Method: We selected 24 patients with CM II and 24 without CM II. DSM-IV criteria and a neuropsychological analysis were applied in all. All patients underwent full night polysomnography. Results: 14 CM II patients presented sleep apnea syndrome, REM sleep behavior disorder and periodic limb movement in sleep; six patients without CM II presented sleep apnea syndrome. Among these patients, 12 (six with CM II and six without CM II) presented attention deficit related to the sleep disorders. Conclusion: Sleep disorders may impair cognitive functions, as attention, and contribute to poor quality of learning also in patients with CM II.KEy WORDS: polysomnography, REM sleep behavior disorder, apnea, cognition, attention deficit disorder. Distúrbios do sono: possível causa de déficit de atenção em crianças e adolescentes com malformação de Chiari tipo IIResumo -Introdução: Déficits de atenção podem estar relacionados a distúrbios do sono em indivíduos com malformação de Chiari tipo II (CM II). Nosso objetivo é identificar distúrbios do sono e sua contribuição para a ocorrência de déficit de atenção. Método: Foram selecionados 24 pacientes com CM II e 24 sem CM II. Todos foram submetidos à avaliação neuropsicológica, aos critérios do DSM-IV e a polissonografia. Resultados: 14 pacientes com CM II apresentaram síndrome da apnéia do sono, distúrbio do comportamento da fase do sono REM e movimentos periódicos dos membros em sono; seis pacientes sem CM II apresentaram síndrome da apnéia do sono. Entre estes pacientes, 12 (seis com CM II e seis sem CM II) apresentaram déficit de atenção relacionado a distúrbios do sono. Conclusão: Distúrbios do sono podem prejudicar funções cognitivas, como a atenção, contribuindo para a piora da qualidade de aprendizado também em pacientes com CM II.PAlAVRAS-ChAVE: polissonografia, distúrbio do comportamento da fase do sono com movimentos oculares rápidos, apnéia, cognição, transtorno do déficit de atenção. The central nervous system (CNS) abnormality characterized by herniation of cerebellar tonsils below the plane of foramen magnum was initially described by Chiari in 1891. Subsequently, the same author expanded the spectrum of abnormalities of the craniocervical junction including disorders that are currently recognized as Chiari malformation (CM) type I, II, III and IV. These congenital disorders disclose complex physical and neuropsychological symptomatology and are associated with developmental anomalies of both the spine and brain 1 . The CM type II (CM II) is characterized by the descent of the inferior vermis and cerebellar hemispheres through the foramen magnum with a displacement of the brain stem (medulla, fourth ventricle, and lower portion of the pons) inside the spinal canal, resulting in aqueduct and fourth ventricle elongation 1,2 . Myelomeningocele is present in almost all c...

Scoring atonia during normal and pathological rapid eye movement sleep: Visual and automatic quantification methods

“…A minor modification over the subsequent years was the adaptation of the original epoch lengths of 20‐ to 30‐s intervals 4,33–41 . Because the amplitude for scoring tonic activations was not specified in the original paper, several subsequent studies have explicitly defined amplitude criteria such as an increase of more than 2 µV above the baseline, 42 amplitude greater than twice the individual level of atonia and greater than 10 µV, 43–46 or greater than twice the EMG amplitude during N3 sleep 47 . This last modification is similar to the definition of the AASM, 2 which asks for amplitudes greater than the minimum amplitude during NREM sleep.…”

“…A further, more laborious scoring considered tonic activity with amplitudes greater than four times the lowest amplitude during the present REM episode 48 . All except one study 49 considered tonic activation of chin EMG to be present when 50% or more of an epoch of 7.5, 50 20, 15–32,43–46 or 30 s 2,4,33–42,47,48,51–53 contained such an activity. As to whole night quantification of tonic activity during REM sleep, there has been broad consensus across studies to quantify loss of atonia as the percentage of epochs containing tonic activity compared with the total number of REM epochs (Table 1).…”

“…In addition, Eisensehr and coworkers classified 10‐s epochs as containing long EMG activity when the sum of the individual activations at least 0.5 s long was longer than 1 s, or with short activity when the same interval contained more than 10 activations shorter than 0.5 s 59 . The multitude of duration criteria is matched by the diversity of amplitude definitions, which have been given as greater than four times the background activity, 2,4,16–27,29,31–34,36–38,40–42,44,45,47,51,52,56–58,60,61 two times the background, 35,62,63 or greater than 50 µV 28 . Other approaches proposed amplitudes greater than four times the lowest amplitude during the current REM episode, 48 1.5 times the preceding atonia amplitude, 48,49,59 or four times the presleep baseline 54 .…”

Psychosocial and somatic outcomes of sleep problems in children: a 4‐year follow‐up study

“…; Pakyurek et al . ) and inattention in children with developmental disabilities (Henriques Filho & Pratesi ).…”

A Successful Pregnancy Outcome after Surgical Decompression of Type I Arnold-Chiari Malformation

“…Dysfunction of brainstem and lower cranial nerve are the most serious features of this form [8]. ACM type III refers to herniation of cerebellum into a high cervical myelomeningocoele and type IV is cerebellar agenesis [9].…”