Is MRI Necessary in the Evaluation of Pediatric Central Sleep Apnea?

Woughter, Meghan; Perkins, Amy M.; Baldassari, Cristina M.

doi:10.1177/0194599815597215

Cited by 15 publications

(14 citation statements)

References 17 publications

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“…Brain abnormalities were most common among syndromic children with mixed OSA and CSA in the absence of adenotonsillar hypertrophy. Similarly, in a study by Woughter et al, the majority of the brain MRI abnormalities were documented in children with comorbid medical conditions; however, prevalence of abnormalities were similar among children with CSA and those with mixed OSA and CSA.…”

Section: Discussionmentioning

confidence: 60%

Utility of brain MRI in children with sleep‐disordered breathing

et al. 2016

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Section: Discussionmentioning

confidence: 60%

Utility of brain MRI in children with sleep‐disordered breathing

et al. 2016

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“…They typically need to consider whether further investigations (e.g. neuroimaging) are required to determine the underlying cause of these breathing instabilities . In the age group assessed in the present study, neuroimaging often requires the child to undergo a general anaesthetic, which has its own inherent risks, in addition to being anxiety provoking for parents.…”

Section: Discussionmentioning

confidence: 99%

“…A finding of an elevated central apnoea index (CAI) on polysomnographic (PSG) studies in children having investigation for symptoms of obstructive sleep apnoea (OSA) but who do not have OSA by PSG criteria raises the clinical question of the need for further investigations, including neuroimaging . The likelihood of finding a significant intracranial abnormality in children with a mildly elevated CAI appears to be low, but the reason these children have a frequency of central apnoeas outside the expected range is not known.…”

Section: Introductionmentioning

confidence: 99%

Assessing ventilatory control stability in children with and without an elevated central apnoea index

et al. 2019

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Background and objective Frequent central apnoeas are sometimes observed in healthy children; however; the pathophysiology of an elevated central apnoea index (CAI) is poorly understood. A raised CAI may indicate underlying ventilatory control instability (i.e. elevated loop gain, LG) or a depressed ventilatory drive. This pilot study aimed to compare LG in otherwise healthy children with an elevated CAI to healthy controls. Methods Polysomnographic recordings from children (age > 6 months) without obstructive sleep apnoea and with a CAI > 5 events/h (n = 13) were compared with age and gender‐matched controls with a CAI < 5 events/h (n = 13). Spontaneous sighs were identified during non‐rapid eye movement (NREM) sleep, and breath–breath measurements of ventilation were derived from the nasal pressure signal. A standard model of ventilatory control (gain, time constant and delay) was used to calculate LG by transforming ventilatory fluctuations seen in response to a sigh into a ventilatory‐drive signal that best matches observed ventilation. Results The high CAI group had an elevated LG (median = 0.36 (interquartile range, IQR = 0.35–0.53) vs 0.28 (0.23–0.36); P ≤ 0.01). There was no difference in either the time constant (P = 0.63) or delay (P = 0.29) between groups. Elevated LG observed in the high CAI group remained after accounting for degree of hypoxia (average oxygen saturation (SpO2) during each analysable window) experienced (0.40 (0.30–0.53) vs 0.25 (0.23–0.37); P = 0.04). Conclusion An elevated CAI in otherwise healthy children is associated with a raised LG compared to matched controls with a low CAI, irrespective of level of hypoxia. This relative ventilatory instability helps explain the high CAI and may ultimately be able to help guide diagnosis and management in patients with high CAI.

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“…However, they are not routinely used. For example, patients with central nervous system abnormalities may have specific aspects of cerebral CT or MRI examination (10).…”

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confidence: 99%

Central Sleep Apnea – a Rare Cause for Acute Respiratory Insufficiency in Children. Case Report

Popescu

Ionescu

Balan

et al. 2018

Maedica

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Central sleep apnea is characterized by frequent cessation of breathing during sleep, resulting in repetitive episodes of insufficient ventilation and abnormalities of acid-base balance. It may be primary or secondary, and it is uncommon in children, with limited data for this population. We present here the case of a five-year-old girl, known to have thoracolumbar myelomeningocele (for which she underwent a surgical procedure in infancy), secondary hydrocephalus (with a ventriculoperitoneal shunt) and flaccid paralysis, who was admitted in our hospital with prolonged fever syndrome, productive cough, severe dyspnea and perioral cyanosis. Following physical examination, laboratory investigations and thoracic radiography, we established the diagnosis of aspiration pneumonia with acute respiratory failure. Medical treatment with multiple systemic antibiotics, antifungal agents, systemic and inhaled bronchodilator, oxygen therapy and respiratory nursing were initiated, with favorable evolution. During the entire hospitalization, the patient showed nocturnal respiratory rhythm disorders, with sleep apnea crisis of approximately 20 seconds and desaturation, followed by severe hypercapnic respiratory acidosis, manifestations that persisted even after the remission of pulmonary infection, raising the suspicion of an apnea syndrome. After excluding the causes of obstructive apnea, a cerebral CT scan was performed, revealing isolated fourth ventricle compressing the brainstem. The patient underwent neurosurgical intervention and postoperatively, the evolution was favorable, with remission of apnea crisis.

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Is MRI Necessary in the Evaluation of Pediatric Central Sleep Apnea?

Cited by 15 publications

References 17 publications

Utility of brain MRI in children with sleep‐disordered breathing

Utility of brain MRI in children with sleep‐disordered breathing

Assessing ventilatory control stability in children with and without an elevated central apnoea index

Central Sleep Apnea – a Rare Cause for Acute Respiratory Insufficiency in Children. Case Report

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