Utility of brain MRI in children with sleep‐disordered breathing

Abstract

4. Laryngoscope, 2016 127:513-519, 2017.

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

“…This finding remained after controlling for differences in the level of hypoxia experienced (as it is well known that LG rises with increasing levels of hypoxia) . The extent to which an elevated CAI, particularly in children who are otherwise healthy, might be indicative of any underlying physiological abnormality (particularly in the neural circuitry controlling breathing) is currently a topic of debate in the field . Nonetheless, knowledge of the underlying LG may begin to help unravel this question of the pathological significance of a mildly elevated CAI.…”

“…These events are often considered normal physiological events due to an ongoing maturation of the respiratory control system, with frequency of events decreasing over the first year of life . However, both an increase in frequency of central apnoeas as well as the pattern and duration of these events during sleep raise the possibility of an underlying intracranial pathology affecting the respiratory control centres, such as Arnold Chiari malformation or an acquired brain stem lesion . In contrast, higher numbers of central apnoeas are also seen in children with obstructive sleep‐disordered breathing, likely due to hyperventilation associated with the arousals that follow obstructive events triggering central apnoeas upon return to sleep .…”

“…In contrast, higher numbers of central apnoeas are also seen in children with obstructive sleep‐disordered breathing, likely due to hyperventilation associated with the arousals that follow obstructive events triggering central apnoeas upon return to sleep . 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.…”

Neuropsychological Alterations in Children Affected by Obstructive Sleep Apnea Syndrome

“…In pediatric population, the main risk factor is adenotonsillar hypertrophy [11,12], but others are rhinitis [13], nasal structure alteration [14,15], cleft palate, velopharyngeal flap surgery, pharyngeal masses, craniofacial malformations [16], genetic syndrome (i.e. Down syndrome, Crouzon syndrome, and Apert syndrome), genetic hypoplasia mandibular (Pierre Robin syndrome, Treacher Collins syndrome, Shy-Drager syndrome, and Cornelia De Lange syndrome) [17,18], craniofacial traumas [19,20], chronic or seasonal rhinitis [13], asthma [21,22], neuromuscular syndromes [23], brainstem pathologies ( Arnold-Chiari malformation and Joubert syndrome) [24], achondroplasia [25], and mucopolysaccharidosis [26].…”

Pediatric patient with Sleep Disordered Breathing (SDB) of central origin secondary to Arnold Chiari type I malformation: a case report.

“…The current diagnostic reference method for any SDB in children is Polysomnography (PSG), although Cardiorespiratory Polygraphy (CRP) could also be performed if necessary as a first diagnostic approach if the symptomatology is highly suggestive. Other diagnostic methods are also useful for knowing the etiology of SDB such as brain MRI 4 .…”