Obstructive sleep apnea syndrome as a rare presentation in a young girl with a central nervous system tumor

Abstract

Sleep related breathing disorders (SRBDs) are a common problem in infancy and childhood. The most common type of SRBD in this age group is obstructive sleep apnea syndrome (OSAS), generally caused by factors affecting airway patency, such as tonsillar hypertrophy or obesity. However, in adults OSAS can also be caused by processes affecting the brainstem, such as central nervous system tumors. This report describes a 2-year-old girl who presented with symptoms of snoring, restless sleep, repeated night-time waking, and apneic events whilst asleep. She had no co-morbidities, and examination revealed normal sized tonsils. A sleep study demonstrated severe OSAS with an obstructive apnea/hypopnea index of 34. Her OSAS completely resolved on excision of the tumor.The case highlights the importance of neurological examination as part of evaluation of OSAS, especially in cases where tonsils are not enlarged and there are no other risk factors for OSAS.

Central sleep apnoea as an initial presentation of a posterior fossa juvenile pilocytic astrocytoma

“…CSA is rare in the paediatric population,6 although CSA has been rarely reported as a presenting feature of CNS tumours in this age group 7–9. It is unclear whether a tumour diagnosis would have been made in our patient if only obstructive sleep apnoea (OSA) was detected during the sleep study, although OSA has been reported as a presenting feature of a brain tumour in a toddler 10…”

“…[7][8][9] It is unclear whether a tumour diagnosis would have been made in our patient if only obstructive sleep apnoea (OSA) was detected during the sleep study, although OSA has been reported as a presenting feature of a brain tumour in a toddler. 10 The CNS neoplasms in the adult and paediatric cases presenting with apnoea were likely impairing the brainstem neuronal network. Tumours involving the posterior fossa may influence central chemoreceptors and pontine and medullary respiratory groups, consequently producing respiration abnormalities.…”