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: The patient started treatment for central sleep apnea syndrome with ASV (S9 AutosetCS(tm); ResMed Corp., San Diego, CA, USA), with a maximum pressure support of 15cmH2O, a minimum pressure support of 5 cmH2O, an expiratorypressure of 8 cmH2O, and an RR of 15 breaths/min. After six months oftreatment, polysomnography under ASV showed that the respiratory disturbance indeximproved from 108 events/h to 4.8 events/h and that the patient spent 1.4% of sleep timewith oxyhemoglobin saturation < 90% (Figure 3).In addition, there was improvement in gas exchange (FiO2 = 0.21; pH = 7.36;PaO2 = 69 mmHg; PaCO2 = 46 mmHg; and SaO2 =93%).