Lam B, Ryan CF
Division of Respiratory Medicine, University of British Columbia, Vancouver, Canada
Sleep Med. 2000 Apr 1;1(2):139-144. doi: 10.1016/s1389-9457(99)00004-0.
Sleep apnea syndrome is a recognized manifestation of Arnold-Chiari malformation that almost invariably has been described in association with other neurological findings. We report a 39-year-old man who presented with severe daytime hypersomnolence. A detailed neurological examination was completely normal. Polysomnography revealed moderately severe mixed central and obstructive sleep apnea and hypopnea with persistence of central apnea and hypersomnolence despite nasal continuous positive airway pressure therapy. A history of severe headaches precipitated by sustained laughter prompted the consideration of an Arnold-Chiari malformation (ACM). A type I ACM with no evidence of syringomyelia or hydrocephalus was confirmed by MRI and successfully decompressed by suboccipital craniotomy and upper cervical laminectomies. Post-operatively the patient's headaches and hypersomnolence disappeared and a repeat polysomnography showed marked improvement in the sleep-disordered breathing. Physicians should be aware that severe sleep- disordered breathing may be the initial and sole presenting feature of Arnold-Chiari malformation.
睡眠呼吸暂停综合征是阿诺德-奇亚里畸形的一种公认表现，几乎总是与其他神经学表现相关联。我们报告一名39岁男性，他表现为严重的日间嗜睡。详细的神经系统检查完全正常。多导睡眠图显示中度严重的中枢性和阻塞性混合性睡眠呼吸暂停及呼吸不足，尽管进行了鼻持续气道正压通气治疗，中枢性呼吸暂停和嗜睡仍持续存在。因持续大笑引发严重头痛的病史促使考虑阿诺德-奇亚里畸形（ACM）。MRI证实为I型ACM，无脊髓空洞症或脑积水证据，并通过枕下开颅术和上颈椎椎板切除术成功减压。术后患者的头痛和嗜睡消失，重复多导睡眠图显示睡眠呼吸障碍明显改善。医生应意识到严重的睡眠呼吸障碍可能是阿诺德-奇亚里畸形的初始且唯一表现特征。
