MRI Findings and Sleep Apnea in Children With Chiari I Malformation
Division of Respiratory Disease, Department of Pediatric Medicine, Boston Children's Hospital, Boston, Massachusetts. Pediatric Neurology
(Impact Factor: 1.7).
04/2013; 48(4):299-307. DOI: 10.1016/j.pediatrneurol.2012.12.009
Chiari I malformation is characterized by downward herniation of the cerebellar tonsils through the foramen magnum. Scant data are available on the clinical course, relationship to the extent of herniation on magnetic resonance imaging in Chiari I malformation and the presence of sleep-disordered breathing on polysomnography. Retrospective analysis was performed looking at polysomnographic findings of children diagnosed with Chiari I malformation. Details on how Chiari I malformation was diagnosed, brainstem magnetic resonance imaging findings, and indications for obtaining the polysomnogram in these patients were reviewed. We also reviewed available data on children who had decompression surgery followed by postoperative polysomnography findings. Twenty-two children were identified in our study (11 males, median age 10 years, range 1 to 18). Three had central sleep apnea, five had obstructive sleep apnea, and one had both obstructive and central sleep apnea. Children with sleep-disordered breathing had excessive crowding of the brainstem structures at the foramen magnum and were more likely to have a greater length of herniation compared with those children without sleep-disordered breathing (P = 0.046). Patients with central sleep apneas received surgical decompression, and their conditions were significantly improved on follow-up polysomnography. These data suggest that imaging parameters may correlate with the presence of sleep-disordered breathing in children with Chiari I malformation.
Available from: Rodrigo Martins
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ABSTRACT: Numerous medical disorders can lead to CSA or sleep hypoventilation (Fig. 4). Disorders that affect respiratory control centers or chemoreceptor function can lead to inadequate drive to breathe during sleep when wakefulness neurocompensatory mechanisms are absent. A diminished ability to translate central respiratory drive into adequate ventilation can also be caused by pathologic conditions arising from impairment lower down the neuraxis, including respiratory muscle weakness. Some medical disorders may have dysfunction on multiple levels (see Fig. 4). A bidirectional relationship likely exists for many of these conditions, such that the primary medical disorder causes or worsens the CSA and its adverse effects while the primary medical condition and its associated symptoms are worsened by the CSA. There is a need to explore these relationships and improve the understanding of the underlying mechanisms mediating the link between certain medical conditions and CSA, and the potential to intervene to improve health outcomes.
Available from: Giacomo Della Marca
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