Utility of MRI in Workup of Pediatric Central Sleep Apnea

Abstract

Objective: 1) To determine the incidence of central nervous system pathology on magnetic resonance imaging (MRI) scans in children with central sleep apnea (CSA). 2) To assess whether certain factors such as abnormalities on neurologic examination impact the yield of MRI in evaluation of CSA.Method: A retrospective chart review was conducted at a tertiary pediatric hospital over 10 years. Inclusion criteria were patients 6 months to 18 years of age who underwent both fullnight polysomnogram (PSG) and head MRI. Children with central apnea index (CAI) greater than 1 were considered to have CSA.Results: Thirty-six children were included. Sixteen patients were boy (44.4%), and the mean age was 43.2 ± 52.2 months. Twenty children (55.6%) had CAI greater than 1. Fourteen children (38.9%) had evidence of pathology on MRI, with the most common finding (n = 5) being arachnoid cyst. When patients with CSA were compared to those without CSA, there was no significant difference (P = .23) in rates of abnormal head MRI. The presence of OSA on PSG did not predict (P = .54) pathologic findings on MRI. In CSA patients, the presence of either developmental delay or an abnormal neurologic exam improved the diagnostic yield of MRI.Conclusion: CAI greater than 1 did not predict the presence of pathology on head MRI. Thus, the routine use of MRI in evaluation of CSA is not recommended. Further research is necessary to determine if there are other diagnostic tests that can be utilized in evaluation and management of pediatric CSA.Objective: To verify the use of electronic device (iPods, MP3s, cell phones, and PCs) by teenagers who are students in public schools of São Paulo, Brazil.Method: Carried out in a school in São Paulo/Brazil in 2011 and involving students from 10 to 17 years. The sample answered a questionnaire containing questions which referred to electronic devices: type of phones (external, internal, and occlusive), times and places used, elevated volume. Chisquare was done and considered P < .05.Results: Among the 249 teenagers studied, 55.8% were girls, the average age was 12.6 years (±1.42 years). Use of phones: 89.9% girls and 73.6% boys (P = .01). Type: 17% external, 18.9% internal, and 64.1% occlusive. Time of usage: cell phone, ->1 h/d by 26.4% girls and 38.3% boys (P = .03); iPod/MP3, ->1 h/d by 26.4% girls and 18.5% boys (P = .06). Related to the places: 50% streets, 87% home, 45% car, 31% subway, 47% bus, and 21% park. Elevated volume in cell phone: 28% by girls and 35.8% by boys (P = .83); in iPod/ MP3, 16.7% and 25.9% (P = .06) for girls and boys, respectively. Conclusion:The elevated percentage of teenagers using electronic devices in an inadequate way points to the necessity of concerning the topic as a way to avoid risks and future auditory loss.Objective: To evaluate weight change in the pediatric population after tonsillectomy and identify associated risk factors for weight loss.