Reybet-Degat O
Service de Pneumologie et Réanimation Respiratoire, CHU, Dijon.
Rev Neurol (Paris). 2001 Nov;157(11 Pt 2):S156-60.
Sleep apnea is a manifestation which has recently been recognized in anomalies of craniovertebral junction. The main reported cases involve Arnold-Chiari malformation, and clinical manifestation is a central sleep apnea syndrome. The pathophysiological mechanisms of such a sleep apnea are a blunted bulbar chemical drive (in hypercapnic patients) or an increased bulbar chemical drive which destabilizes the breathing pattern during sleep (in normo/hypocapnic patients). As this sleep apnea can be the initial manifestation of a Arnold-Chiari malformation, craniocervical magnetic resonance imaging is recommended when a central sleep apnea without evident aetiology is discovered in a young patient. Other anomalies, such as bone malformations (platybasia for example) or syryngobulbomyelia can be involved. Other respiratory manifestations can be observed such as obstructive sleep apnea syndrome, diaphragmatic or vocal cord paralysis. These manifestations may be life-threatening and may lead to decompressive surgery.
睡眠呼吸暂停是一种最近在颅颈交界区异常中被认识到的表现。主要报道的病例涉及阿诺德-基亚里畸形，临床表现为中枢性睡眠呼吸暂停综合征。这种睡眠呼吸暂停的病理生理机制是延髓化学驱动减弱（在高碳酸血症患者中）或延髓化学驱动增加，这会破坏睡眠期间的呼吸模式（在正常/低碳酸血症患者中）。由于这种睡眠呼吸暂停可能是阿诺德-基亚里畸形的初始表现，因此当在年轻患者中发现无明显病因的中枢性睡眠呼吸暂停时，建议进行颅颈磁共振成像检查。其他异常，如骨骼畸形（例如扁平颅底）或脊髓空洞症也可能涉及。还可观察到其他呼吸表现，如阻塞性睡眠呼吸暂停综合征、膈肌或声带麻痹。这些表现可能危及生命，并可能导致减压手术。
