Chiari malformation and sleep related breathing disorders
- Y Dauvilliers1,
- V Stal3,
- B Abril1,
- P Coubes4,
- S Bobin5,
- J Touchon1,
- P Escourrou3,
- F Parker6,
- P Bourgin7
- 1Service de Neurologie, Hôpital Gui-de-Chauliac, INSERM U888 Montpellier, France
- 3Sleep Laboratory, Hôpital Antoine Béclère, Clamart, Paris XI University, France
- 4Service de Neurochirurgie B, Hôpital Gui-de-Chauliac, Montpellier, France
- 5Department of Oto-Rhino-Laryngology, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris XI University, France
- 6Neurosurgery Department, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris XI University, France
- 7Sleep Laboratory, Hôpital Antoine Béclère, Clamant, Paris X1 University, France, and Department of Biological Sciences and Department of Psychiatry, Stanford University, Stanford, California, USA
- Dr P Bourgin, Department of Biological Sciences and Department of Psychiatry, Stanford University, 371 Serra Mall, Stanford, CA 94305-5020, USA; bourgin{at}stanford.edu
- Received 12 October 2006
- Revised 6 February 2007
- Accepted 9 March 2007
- Published Online First 30 March 2007
Abstract
Objective: To estimate the frequency, mechanisms and predictive factors of sleep apnoea syndrome (SAS) in a large group of children and adults with type I (CMI) and II (CMII) Chiari malformation (CM).
Background: The anatomical and functional integrity of both respiratory circuits and lower cranial nerves controlling the upper airway is necessary for breathing control during sleep. These latter structures may be altered in CM, and a few investigations have reported CM related sleep disordered breathing.
Methods: Forty-six consecutive unrelated patients with CM (40 CMI, six CMII), of which 20 were children (eight males) and 26 were adults (12 males), underwent physical, neurological and oto-rhino-laryngoscopic examination, MRI and polysomnography.
Results: SAS was present in 31 (67.4%) of the patients with CM (70% of CMI, 50% of CMII, including mainly children). Sixty per cent of children with CM exhibited SAS, including 35% with obstructive (OSAS) and 25% with central (CSAS) sleep apnoea syndrome. SAS was observed in 73% of CM adults (57.7% OSAS, 15.4% CSAS). Severe SAS was found in 23% of CM adults. Multiple regression analysis revealed that age, type II Chiari and vocal cord paralysis predicted the central apnoea index.
Conclusion: SAS is highly prevalent in all age groups of patients suffering from CM. CSAS, a rare condition in the general population, was common among the patients with CM in our study. Sleep disordered breathing associated with CM may explain the high frequency of respiratory failures observed during curative surgery of CM. Our results suggest that SAS should be systematically screened for in patients with CM, especially before surgery.
Footnotes
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Competing interests: None.
- Abbreviations:
- AHI
- apnoea/hypopnoea index
- BMI
- body mass index
- CAI
- central apnoea index
- CM
- Chiari malformation
- CSAS
- central sleep apnoea syndrome
- ESS
- Epworth Sleepiness Scale
- OAI
- obstructive apnoea index
- OSAS
- obstructive sleep apnoea syndrome
- PSG
- polysomnography
- SAS
- sleep apnoea syndrome
- SDB
- sleep disordered breathing
