Patel DM, Rocque BG, Hopson B, Arynchyna A, Bishop ER, Lozano D, Blount JP. (2015) Sleep-disordered breathing in patients with myelomeningocele.
J Neurosurg Pediatr. 2015 Apr 3:1-6.Abstract
OBJECT
A paucity of literature examines sleep apnea in patients with
myelomeningocele, Chiari malformation Type II (CM-II), and related
hydrocephalus. Even less is known about the effect of hydrocephalus
treatment or CM-II decompression on sleep hygiene. This study is an
exploratory analysis of sleep-disordered breathing in patients with
myelomeningocele and the effects of neurosurgical treatments, in
particular CM-II decompression and hydrocephalus management, on sleep
organization. METHODS The authors performed a retrospective review of
all patients seen in their multidisciplinary spina bifida
clinic (approximately 435 patients with myelomeningocele) to evaluate
polysomnographs obtained between March 1999 and July 2013. They analyzed
symptoms prompting evaluation, results, and recommended interventions
by using descriptive statistics. They also conducted a subset analysis
of 9 children who had undergone polysomnography both before and after
neurosurgical intervention. RESULTS Fifty-two patients had
polysomnographs available for review. Sleep apnea was diagnosed in 81%
of these patients. The most common presenting symptom was "breathing
difficulties" (18 cases [43%]). Mild sleep apnea was present in 26 cases
(50%), moderate in 10 (19%), and severe in 6 (12%). Among the 42
patients with abnormal sleep architecture, 30 had predominantly
obstructive apneas and 12 had predominantly central apneas. The most
common pulmonology-recommended intervention was adjustment of peripheral
oxygen supplementation (24 cases [57%]), followed by initiation of
peripheral oxygen (10 cases [24%]). In a subset analysis of 9 patients
who had sleep studies before and after neurosurgical intervention, there
was a trend toward a decrease in the mean number of respiratory events
(from 34.8 to 15.9, p = 0.098), obstructive events (from 14.7 to 13.9, p
= 0.85), and central events (from 20.1 to 2.25, p = 0.15) and in the
apnea-hypopnea index (from 5.05 to 2.03, p = 0.038, not significant when
corrected for multiple measures). CONCLUSIONS A large proportion of
patients with myelomeningocele who had undergone polysomnography showed
evidence of disordered sleep on an initial study. Furthermore, 31% of
patients had moderate or severe obstructive sleep apnea.
Myelomeningocele patients with an abnormal sleep structure who had
undergone nonoperative treatment with peripheral oxygen supplementation
showed improvement in the apnea-hypopnea index. Results in this study
suggested that polysomnography in patients with myelomeningocele may
present an opportunity to detect and classify sleep apnea, identify
low-risk interventions, and prevent future implications of
sleep-disordered breathing.
