Sleep-disordered breathing in children with Chiari malformation type II and myelomeningocele.

BACKGROUND

The prevalence of sleep-disordered breathing (SDB) in children with Chiari malformation type II (CM-II), a known association of neural tube defects (NTD), has not been well documented. The aim of the present study was to assess the prevalence and possible predictive factors of SDB in patients with CM-II.

METHODS

The study included all patients with documented CM-II who were routinely referred from the Neurosurgery Clinic to the University Sleep Disorders Centre at King Khalid University Hospital, Riyadh, Saudi Arabia, between January 2002 and July 2009. Overnight full polysomnography (PSG) was performed in all patients. Polysomnographic data were analyzed using descriptive statistics.

RESULTS

Sixteen children (11 boys, five girls) were included in the study; their mean age was 4.7 years (range, 0.8-10 years) and their mean body mass index was 18.05 kg/m(2) (range, 15.4-25.4 kg/m(2) ). For the whole group, the mean apnea-hypopnea index (AHI) was 6.3/h (range, 0.2-24.5/h), with AHI recorded as >5/h in five patients (31.3%) and ≥ 10/h in three patients (18.8%). The mean central apnea-hypopnea index was 5.9/h (range, 0-24.5/h) and the mean obstructive apnea-hypopnea index was 0.4/h (range, 0-2.9/h). The mean arousal index was 15.1/h (range, 5-34/h).

CONCLUSION

The major assumption linking CM-II and NTD with potential brainstem compression and respiratory dysfunction during sleep was confirmed. Indeed, SDB is highly prevalent, and clearly underreported and undertreated in patients with CM-II associated with NTD.