Chiari malformation and central sleep apnea syndrome: efficacy of treatment with adaptive servo-ventilation.
Bottom Line: An arterial blood gas analysis showed hypercapnia.Polysomnography showed a respiratory disturbance index of 108 events/h, and all were central apnea events.Treatment with adaptive servo-ventilation was initiated, and central apnea was resolved.
Affiliation: Tondela-Viseu Hospital Center, Viseu, Portugal.
The Chiari malformation type I (CM-I) has been associated with sleep-disordered breathing, especially central sleep apnea syndrome. We report the case of a 44-year-old female with CM-I who was referred to our sleep laboratory for suspected sleep apnea. The patient had undergone decompressive surgery 3 years prior. An arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory disturbance index of 108 events/h, and all were central apnea events. Treatment with adaptive servo-ventilation was initiated, and central apnea was resolved. This report demonstrates the efficacy of servo-ventilation in the treatment of central sleep apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a history of decompressive surgery.
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Mentions: A chest X-ray was unremarkable. There was no evidence of cardiovascular comorbidities(an echocardiogram and a Holter examination were unremarkable). Thyroid function wasnormal. An arterial blood gas analysis showed severe hypoxemia with mild hypercapnia(FiO2 = 0.21; pH = 7.35; PaO2 = 51 mmHg; PaCO2 = 56mmHg; and SaO2 = 89%). Respiratory function test results revealed a slightreduction in FVC, a reduction in expiratory reserve volume and a preserved TLC.Polysomnography showed low sleep efficiency (44.4%), with 333 central respiratoryevents, a respiratory disturbance index of 108 events/h, and 27.6% of sleep time withoxyhemoglobin saturation < 90% (Figure 2).