Sleep Disordered Breathing and Magnetic Resonance Imaging Findings in Children With Chiari Malformation Type I

El‐Kersh, Karim; Cavallazzi, Rodrigo; Fernández, Alicia; Moeller, Karen; Senthilvel, Egambaram

doi:10.1016/j.pediatrneurol.2017.08.001

Cited by 9 publications

(8 citation statements)

References 4 publications

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“…Only a few studies have evaluated the prevalence of SAS together with the clinical and neuroradiological features of CM. These studies reported a prevalence of SAS ranging from 24% to 70% in children with CM‐I, which may be explained by differences in population and PSG scoring criteria 8,12–17 . In our study, the prevalence of SAS ranged from 50% to 80% according to the different sub‐groups of CM‐I, with a prevalence ranging from 20% to 30% when considering only moderate‐to‐severe SAS.…”

Section: Discussionmentioning

confidence: 51%

“…These studies reported a prevalence of SAS ranging from 24% to 70% in children with CM-I, which may be explained by differences in population and PSG scoring criteria. 8,[12][13][14][15][16][17] In our study, the prevalence of SAS ranged from 50% to 80% according to the different sub-groups of CM-I, with a prevalence ranging from 20% to 30% when considering only moderate-to-severe SAS. This prevalence may even have been underestimated as patients had a PG and not a PSG.…”

Section: Follow-upmentioning

confidence: 50%

“…In our center, all the patients with a CM suspicion had a MRI before the PG, as in the study of Losurdo et al 17 who observed a 24% prevalence of SAS. Concerning MRI findings, some studies 14,17 found a higher prevalence of syringomyelia in patients with CM-I and OSA. We did not observe the same results.…”

Section: Follow-upmentioning

confidence: 99%

“…21 Several studies have tried to identify clinical and/or radiological risk factors for SAS to prioritize patients for a P(S)G, but none showed conclusive results. [12][13][14]16 Thus, a systematic P(S)G for all CM-I patients seems still highly recommended.…”

Section: Follow-upmentioning

confidence: 99%

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Impact of sleep‐disordered breathing on the management of children with Chiari malformation type I

Vagianou

Khirani

Denis

et al. 2022

Pediatric Pulmonology

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Objectives: Children with Chiari malformation type I (CM-I) have an increased risk of sleep apnea. The aim of the study was to describe the management of CM-I patients in relation to symptoms, magnetic resonance imaging (MRI) findings and sleep apnea syndrome (SAS). Methods: We performed a retrospective analysis of clinical charts of all 57 CM-I patients seen between September 2013 and April 2017. Results: A total of 45 patients had isolated CM-I or associated co-morbidity (CM-Iia), 5 had craniosynostosis (CM-Ics), and 7 a polymalformative syndrome (CM-Ipm). The prevalence of SAS, defined as an apnea-hypopnea index >1 event/h, was high in CM-I ranging from 50% to 80% according to the CM-I group. The prevalence of central sleep apnea (CSA) was low, with 5 (9%) patients having CSA and only 3 patients with CM-Iia having isolated CSA. A total of 17 patients (30%) had foramen magnum decompression (FMD). Neither positive symptoms of CM-I nor MRI findings alone, nor both combined were good indicators for FMD. No correlation was observed between the cerebellar tonsil descent and SAS in CM-I. But all 5 patients with CSA had a FMD. The combination of MRI findings and/or symptoms of CM-I together with moderate-to-severe SAS best discriminated patients who needed a FMD. Conclusion: Our findings highlight the importance of a combined evaluation of symptoms, MRI and polygraphy results in the management of CM-I patients.

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Section: Discussionmentioning

confidence: 51%

Section: Follow-upmentioning

confidence: 50%

Section: Follow-upmentioning

confidence: 99%

Section: Follow-upmentioning

confidence: 99%

See 2 more Smart Citations

Impact of sleep‐disordered breathing on the management of children with Chiari malformation type I

Vagianou

Khirani

Denis

et al. 2022

Pediatric Pulmonology

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“…Sleep-disordered breathing has been generally regarded to be an indication for Chiari decompression surgery. Other studies have examined the resolution or persistence of sleep-disordered breathing after Chiari decompression surgery [6,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. However, the large majority of these studies were either case studies or small case series, few of them considered pediatric cohorts, and fewer still considered the effects of ENT intervention on sleep apnea in CM-1 patients.…”

Section: Discussion/conclusionmentioning

confidence: 99%

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

et al. 2022

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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.

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Congenital Diseases Predisposing to Sleep Apnea

Bue

Salvaggio

Insalaco

2020

Noninvasive Ventilation in Sleep Medicine and Pulmonary Critical Care

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Sleep Disordered Breathing and Magnetic Resonance Imaging Findings in Children With Chiari Malformation Type I

Cited by 9 publications

References 4 publications

Impact of sleep‐disordered breathing on the management of children with Chiari malformation type I

Impact of sleep‐disordered breathing on the management of children with Chiari malformation type I

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

Congenital Diseases Predisposing to Sleep Apnea

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