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Sleep-disordered breathing in patients with myelomeningocele.
J Neurosurg Pediatr. 2015 Jul; 16(1):30-5.JN

Abstract

OBJECT A paucity of literature examines sleep apnea in patients with myelomeningocele, Chiari malformation Type II (CM-II), and related hydrocephalus. Even less is known about the effect of hydrocephalus treatment or CM-II decompression on sleep hygiene. This study is an exploratory analysis of sleep-disordered breathing in patients with myelomeningocele and the effects of neurosurgical treatments, in particular CM-II decompression and hydrocephalus management, on sleep organization.

METHODS

The authors performed a retrospective review of all patients seen in their multidisciplinary spina bifida clinic (approximately 435 patients with myelomeningocele) to evaluate polysomnographs obtained between March 1999 and July 2013. They analyzed symptoms prompting evaluation, results, and recommended interventions by using descriptive statistics. They also conducted a subset analysis of 9 children who had undergone polysomnography both before and after neurosurgical intervention.

RESULTS

Fifty-two patients had polysomnographs available for review. Sleep apnea was diagnosed in 81% of these patients. The most common presenting symptom was "breathing difficulties" (18 cases [43%]). Mild sleep apnea was present in 26 cases (50%), moderate in 10 (19%), and severe in 6 (12%). Among the 42 patients with abnormal sleep architecture, 30 had predominantly obstructive apneas and 12 had predominantly central apneas. The most common pulmonology-recommended intervention was adjustment of peripheral oxygen supplementation (24 cases [57%]), followed by initiation of peripheral oxygen (10 cases [24%]). In a subset analysis of 9 patients who had sleep studies before and after neurosurgical intervention, there was a trend toward a decrease in the mean number of respiratory events (from 34.8 to 15.9, p = 0.098), obstructive events (from 14.7 to 13.9, p = 0.85), and central events (from 20.1 to 2.25, p = 0.15) and in the apnea-hypopnea index (from 5.05 to 2.03, p = 0.038, not significant when corrected for multiple measures).

CONCLUSIONS

A large proportion of patients with myelomeningocele who had undergone polysomnography showed evidence of disordered sleep on an initial study. Furthermore, 31% of patients had moderate or severe obstructive sleep apnea. Myelomeningocele patients with an abnormal sleep structure who had undergone nonoperative treatment with peripheral oxygen supplementation showed improvement in the apnea-hypopnea index. Results in this study suggested that polysomnography in patients with myelomeningocele may present an opportunity to detect and classify sleep apnea, identify low-risk interventions, and prevent future implications of sleep-disordered breathing.

Authors+Show Affiliations

Department of Neurosurgery;Department of Neurosurgery; Section of Pediatric Neurosurgery; and.Section of Pediatric Neurosurgery; and.Section of Pediatric Neurosurgery; and.Section of Pediatric Neurosurgery; and.Department of Pulmonology, Children's Hospital of Alabama and University of Alabama at Birmingham, Alabama.Department of Neurosurgery; Section of Pediatric Neurosurgery; and.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25837889

Citation

Patel, Daxa M., et al. "Sleep-disordered Breathing in Patients With Myelomeningocele." Journal of Neurosurgery. Pediatrics, vol. 16, no. 1, 2015, pp. 30-5.
Patel DM, Rocque BG, Hopson B, et al. Sleep-disordered breathing in patients with myelomeningocele. J Neurosurg Pediatr. 2015;16(1):30-5.
Patel, D. M., Rocque, B. G., Hopson, B., Arynchyna, A., Bishop, E. R., Lozano, D., & Blount, J. P. (2015). Sleep-disordered breathing in patients with myelomeningocele. Journal of Neurosurgery. Pediatrics, 16(1), 30-5. https://doi.org/10.3171/2014.11.PEDS14314
Patel DM, et al. Sleep-disordered Breathing in Patients With Myelomeningocele. J Neurosurg Pediatr. 2015;16(1):30-5. PubMed PMID: 25837889.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sleep-disordered breathing in patients with myelomeningocele. AU - Patel,Daxa M, AU - Rocque,Brandon G, AU - Hopson,Betsy, AU - Arynchyna,Anastasia, AU - Bishop,E Ralee', AU - Lozano,David, AU - Blount,Jeffrey P, Y1 - 2015/04/03/ PY - 2015/4/4/entrez PY - 2015/4/4/pubmed PY - 2015/9/29/medline KW - AHI = apnea-hypopnea index KW - CM-II KW - CM-II = Chiari malformation Type II KW - Chiari malformation Type II KW - ECG = electrocardiography KW - EEG = electroencephalography KW - EMG = electromyography KW - EOG = electrooculography KW - SDB = sleep-disordered breathing KW - hydrocephalus KW - myelomeningocele KW - polysomnograph KW - sleep apnea KW - sleep-disordered breathing SP - 30 EP - 5 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 16 IS - 1 N2 - OBJECT A paucity of literature examines sleep apnea in patients with myelomeningocele, Chiari malformation Type II (CM-II), and related hydrocephalus. Even less is known about the effect of hydrocephalus treatment or CM-II decompression on sleep hygiene. This study is an exploratory analysis of sleep-disordered breathing in patients with myelomeningocele and the effects of neurosurgical treatments, in particular CM-II decompression and hydrocephalus management, on sleep organization. METHODS The authors performed a retrospective review of all patients seen in their multidisciplinary spina bifida clinic (approximately 435 patients with myelomeningocele) to evaluate polysomnographs obtained between March 1999 and July 2013. They analyzed symptoms prompting evaluation, results, and recommended interventions by using descriptive statistics. They also conducted a subset analysis of 9 children who had undergone polysomnography both before and after neurosurgical intervention. RESULTS Fifty-two patients had polysomnographs available for review. Sleep apnea was diagnosed in 81% of these patients. The most common presenting symptom was "breathing difficulties" (18 cases [43%]). Mild sleep apnea was present in 26 cases (50%), moderate in 10 (19%), and severe in 6 (12%). Among the 42 patients with abnormal sleep architecture, 30 had predominantly obstructive apneas and 12 had predominantly central apneas. The most common pulmonology-recommended intervention was adjustment of peripheral oxygen supplementation (24 cases [57%]), followed by initiation of peripheral oxygen (10 cases [24%]). In a subset analysis of 9 patients who had sleep studies before and after neurosurgical intervention, there was a trend toward a decrease in the mean number of respiratory events (from 34.8 to 15.9, p = 0.098), obstructive events (from 14.7 to 13.9, p = 0.85), and central events (from 20.1 to 2.25, p = 0.15) and in the apnea-hypopnea index (from 5.05 to 2.03, p = 0.038, not significant when corrected for multiple measures). CONCLUSIONS A large proportion of patients with myelomeningocele who had undergone polysomnography showed evidence of disordered sleep on an initial study. Furthermore, 31% of patients had moderate or severe obstructive sleep apnea. Myelomeningocele patients with an abnormal sleep structure who had undergone nonoperative treatment with peripheral oxygen supplementation showed improvement in the apnea-hypopnea index. Results in this study suggested that polysomnography in patients with myelomeningocele may present an opportunity to detect and classify sleep apnea, identify low-risk interventions, and prevent future implications of sleep-disordered breathing. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/25837889/Sleep_disordered_breathing_in_patients_with_myelomeningocele_ L2 - https://thejns.org/doi/10.3171/2014.11.PEDS14314 DB - PRIME DP - Unbound Medicine ER -