Abstract
A 4-year-old girl presented with sleep-disordered breathing. Her parents described breathing pauses of up to 20 s and progressive tiredness during the day. Obstructive apneas from an enlarged adenoid were thought to be the most probable cause. However, an adenotomy did not resolve the problem. Polysomnography demonstrated central apneas, and cerebral magnetic resonance imaging revealed a Chiari type I malformation. We describe the differential diagnosis of apnea in children and the role of polysomnography in the distinction between obstructive and central apneas. Conclusion: This case illustrates that, in children with apnea, it is important to consider central causes as well as the more common obstructive causes, even in the absence of additional neurological signs or symptoms.
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Abbreviations
- Apnea:
-
Absence of airflow during ≥2 breaths [7]
- Obstructive apnea:
-
≥90% reduction in airflow with persistent or increased effort to breathe, during ≥2 breaths [7]
- Central apnea:
-
Absent effort to breathe followed by arousal, awakening, or desaturation ≥3% during ≥20 s or during ≥2 breaths [7]
- Obstructive/central hypopnea:
-
≥50% reduction in airflow combined with arousal, awakening, or desaturation ≥3% during ≥90% and ≥2 breaths [7]
- Apnea/Hypopnea index (AHI):
-
The number of apneas and hypopneas per hour. An AHI >1 is considered abnormal in children [6]
- Oxygen desaturation index (ODI) (3%):
-
The number of desaturations of >3% from the baseline saturation, measured per hour [7]
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Aarts, L.A.M., Willemsen, M.A.A.P., VandenBussche, N.L.E. et al. Nocturnal apnea in Chiari type I malformation. Eur J Pediatr 170, 1349–1352 (2011). https://doi.org/10.1007/s00431-011-1500-z
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DOI: https://doi.org/10.1007/s00431-011-1500-z