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 paciente iniciou tratamento com SVA com um aparelho Autoset CS S9(tm) (ResMedCorp., San Diego, CA, EUA), com parâmetros de pressão de suporte máxima de 15cmH2O, pressão de suporte mínima de 5 cmH2O, pressãoexpiratória de 8 cmH2O e FR de 15 ciclos/min para a síndrome de apneiacentral do sono. Após seis meses de tratamento, a polissonografia com SVA mostrou umamelhoria do índice de distúrbio respiratório para 4,8 eventos/h e tempo de registrocom saturação da oxi-hemoglobina < 90% de 1,4% (Figura 3). Verificou-se também uma melhoria das trocas gasosas(FiO2 = 0,21; pH = 7,36; PaO2 = 69 mmHg; PaCO2 =46 mmHg; e SaO2 = 93%).