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Chiari malformation and sleep related breathing disorders
  1. Y Dauvilliers1,
  2. V Stal3,
  3. B Abril1,
  4. P Coubes4,
  5. S Bobin5,
  6. J Touchon1,
  7. P Escourrou3,
  8. F Parker6,
  9. P Bourgin7
  1. 1
    Service de Neurologie, Hôpital Gui-de-Chauliac, INSERM U888 Montpellier, France
  2. 3
    Sleep Laboratory, Hôpital Antoine Béclère, Clamart, Paris XI University, France
  3. 4
    Service de Neurochirurgie B, Hôpital Gui-de-Chauliac, Montpellier, France
  4. 5
    Department of Oto-Rhino-Laryngology, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris XI University, France
  5. 6
    Neurosurgery Department, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris XI University, France
  6. 7
    Sleep Laboratory, Hôpital Antoine Béclère, Clamant, Paris X1 University, France, and Department of Biological Sciences and Department of Psychiatry, Stanford University, Stanford, California, USA
  1. 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

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.

http://dx.doi.org/10.1136/jnnp.2006.108779

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    Footnotes

    • 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