A case review of a healthy 3-yearold toddler with a chief complaint of sleep-disordered breathing is presented. The child underwent a pneumogram sleep study with significant abnormal findings. Magnetic resonance imaging led to a diagnosis of Arnold-Chiari type I malformation and the need for posterior fossa decompression. The child has been monitored, and 1 year postoperatively, her sleep apnea has resolved and daytime function and development remain normal. Definitions of the different types of Arnold-Chiari malformation are discussed, with sleep apnea presenting as the only symptom. The importance of a sleep history as part of the practitioner's pediatric assessment is explored.
Clinicians need to be cautious when recommending the side or prone position in this group of high-risk infants. The results in this investigation provide support for the Back to Sleep Campaign recommendations to be applied, not only to healthy term infants, but higher risk infants as well. Studies of the high-risk infant in the supine position are warranted.
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