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 radiografia de tórax não mostrou alterações. Não havia evidência de comorbidadescardiovasculares (ecocardiograma e exame de Holter sem alterações). A função datireoide era normal. A gasometria arterial indicava hipoxemia grave com hipercapnia(FiO2 = 0,21; pH = 7,35; PaO2 = 51 mmHg; PaCO2 =56 mmHg; e SaO2 = 89%). O estudo funcional respiratório revelou umadiminuição leve da CVF com diminuição do volume de reserva expiratória e CPTpreservada. A polissonografia mostrou baixa eficiência do sono (44,4%) com 333eventos respiratórios centrais, um índice de distúrbio respiratório de 108 eventos/he um tempo de registro com saturação da oxi-hemoglobina < 90% de 27,6% (Figura 2).