Improvement of obstructive sleep apneas caused by hydrocephalus associated with Chiari malformation Type II following surgery

Chiari malformation (CM) is the downward herniation of the caudal part of the cerebellum and/or medulla oblongata into the spinal canal. It can alter several neurological functions, including respiratory control and upper airway motility, and can be the cause of sleep-disordered breathing (SDB). The authors describe a 6-year-old boy affected by CM Type II associated with myelomeningocele who showed symptoms indicative of severe airway obstruction during sleep. Polysomnography revealed severe obstructive sleep apnea syndrome (OSAS). Magnetic resonance imaging demonstrated herniation of the cerebellar tonsils and diffuse ventricular dilation with a large pseudocystic formation in the third ventricle. Surgical marsupialization of the cystic wall was performed, associated with ventriculocystostomy and endoscopic replacement of the ventricular catheter. Polysomnography repeated 2 months after surgery revealed a striking improvement in the sleep-related respiratory pattern. The pathogenesis of OSAS was probably referable to a combination of CM and elevated intracranial pressure. However, the striking improvement of symptoms after ventriculoatrial shunt placement suggested that hydrocephalus plays a major role in this condition. Assessment and effective treatment of SDB is crucial in the care of patients with CM.

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Dimensional analysis of the upper airway in obstructive sleep apnea syndrome patients treated with mandibular advancement device: a bi and three‐dimensional evaluation

Journal of Oral Rehabilitation ◽

10.1111/joor.13176 ◽

2021 ◽

Author(s):

Rocío Marco‐Pitarch ◽

Marina Selva‐García ◽

Andrés Plaza‐Espín ◽

Javier Puertas‐Cuesta ◽

Rubén Agustín‐Panadero ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Dimensional Analysis ◽

Sleep Apnea Syndrome ◽

Three Dimensional ◽

Upper Airway ◽

Mandibular Advancement ◽

Obstructive Sleep ◽

Apnea Syndrome

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Sleep disorder: a possible cause of attention deficit in children and adolescents with Chiari malformation type II

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000100008 ◽

2009 ◽

Vol 67 (1) ◽

pp. 29-34 ◽

Cited By ~ 9

Author(s):

Paulo Sérgio Azeredo Henriques Filho ◽

Riccardo Pratesi

Keyword(s):

Sleep Apnea ◽

Sleep Disorders ◽

Attention Deficit ◽

Chiari Malformation ◽

Sleep Apnea Syndrome ◽

Rem Sleep Behavior Disorder ◽

Behavior Disorder ◽

Type Ii ◽

Sleep Behavior ◽

Apnea Syndrome

BACKGROUND: Attention deficit may be related to sleep disorders in Chiari malformation type II (CMII). Our aim is identify sleep disorders and their specific contribution in attention deficit. METHOD: We selected 24 patients with CM II and 24 without CM II. DSM-IV criteria and a neuropsychological analysis were applied in all. All patients underwent full night polysomnography. RESULTS: 14 CM II patients presented sleep apnea syndrome, REM sleep behavior disorder and periodic limb movement in sleep; six patients without CM II presented sleep apnea syndrome. Among these patients, 12 (six with CM II and six without CM II) presented attention deficit related to the sleep disorders. CONCLUSION: Sleep disorders may impair cognitive functions, as attention, and contribute to poor quality of learning also in patients with CM II.

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Upper Airway Collapsibility During REM Sleep in Children with the Obstructive Sleep Apnea Syndrome

SLEEP ◽

10.1093/sleep/32.9.1173 ◽

2009 ◽

Vol 32 (9) ◽

pp. 1173-1181 ◽

Cited By ~ 12

Author(s):

Jingtao Huang ◽

Laurie R. Karamessinis ◽

Michelle E. Pepe ◽

Stephen M. Glinka ◽

John M. Samuel ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Rem Sleep ◽

Sleep Apnea Syndrome ◽

Upper Airway ◽

Obstructive Sleep ◽

Airway Collapsibility ◽

Apnea Syndrome ◽

Upper Airway Collapsibility

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P019 Obstructive sleep apnoea endotypes in people with multiple sclerosis

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.067 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A27-A28

Author(s):

S Carter ◽

H Hensen ◽

A Krishnan ◽

A Chiang ◽

J Carberry ◽

...

Keyword(s):

Multiple Sclerosis ◽

Obstructive Sleep Apnoea ◽

Group Analysis ◽

Respiratory Control ◽

Upper Airway ◽

Sleep Apnoea ◽

Loop Gain ◽

Male Predominance ◽

Arousal Threshold ◽

Obstructive Sleep

Abstract Purpose Obstructive sleep apnoea (OSA) is common in people with multiple sclerosis (MS) despite a lack of typical risk factors for OSA in people with MS such as obesity and male predominance. Therefore, underlying factors other than sex and obesity may be particularly important in the pathogenesis of OSA in people with MS. Thus, the primary aim of this study was to determine the relative contributions of OSA endotypes in people with MS and compare this to matched controls with OSA only. Methods Eleven people with MS and OSA (MS-OSA group) (apnoea-hypopnoea index [AHI]>5events/h) and eleven controls matched for OSA severity, age and sex without MS (OSA group) were studied. Participants underwent a detailed overnight polysomnography with an epiglottic pressure catheter and genioglossus intramuscular electrodes to allow for quantification of pathophysiological contributors to OSA. This included the respiratory arousal threshold, genioglossus muscle responsiveness, respiratory loop gain and upper airway collapsibility. Results Measures of the four primary OSA endotypes were not different between the MS-OSA and OSA groups (e.g. NREM respiratory arousal threshold -27±15 vs. -23±8 cmH2O respectively, p=0.24). Within group analysis indicated higher loop gain in non-obese MS-OSA participants compared to obese MS-OSA participants (0.53±0.11 vs. 0.37±0.11, p=0.04). Conclusions Overall, OSA endotypes are similar between MS-OSA participants and matched OSA controls. However, within the MS-OSA group, non-obese participants have higher loop gain (unstable respiratory control) compared to obese participants. Thus, unstable respiratory control may play an important role in OSA pathogenesis in many people with MS.

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Measurement of pharyngeal segments in Obstructive Sleep Apnea

Brazilian Dental Science ◽

10.14295/bds.2018.v21i1.1486 ◽

2018 ◽

Vol 21 (1) ◽

pp. 64

Author(s):

Marcos Marques Rodrigues ◽

Lucas Borin Moura ◽

Ariane De Souza Oliveira ◽

Marisa Aparecida Cabrini Gabrielli ◽

Valfrido Antonio Pereira Filho ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cone Beam Ct ◽

Sleep Apnea Syndrome ◽

Upper Airway ◽

Cone Beam ◽

Obstructive Sleep ◽

Intimate Relation ◽

The Mean ◽

Cephalometric Measurements

Objective: Obstructive Sleep Apnea (OSA) occurs by recurrent collapse of the upper airway during sleep. It results in complete (apnea) or partial (hypopnea) reduction of airflow and has intimate relation with the upper airway anatomy. Cephalometric analysis has been used to quantify airway dimensions. The aim of this study is evaluate the correlation between the anteroposterior dimension of the upper airway and the severity of obstructive sleep apnea. Material and Methods: A retrospective analysis was performed reviewing polysomnographic data (AHI) and anteroposterior cephalometric measurements of pharynx subregions: nasopharynx, oropharynx, hypopharynx. Results: The sample consisted of 30 patients. The mean body mass index was 29.60 kg/m2 and the average age was 46.8 years. Nine patients presented severe OSA, seven had moderate OSA , seven had mild OSA, and seven were healthy. The Pearson's correlation index between the anteroposterior dimension of the nasopharynx, oropharynx and hypopharynx and AHI was respectively -0.128 (p=0.517), -0.272 (p=0.162) and -0.129 (p=0.513). Conclusion: The correlation between anteroposterior linear dimension of the airway and OSA severity, assessed by AHI, was not positive. As an isolated parameter it did not correlate to the severity of the obstrucive sleep apnea syndrome and should be evaluated in conjunction with other factors. KeywordsUpper Airway; Obstructive sleep apnea; Cone beam CT.

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