Patel Daxa M, Rocque Brandon G, Hopson Betsy, Arynchyna Anastasia, Bishop E Ralee', Lozano David, Blount Jeffrey P
Department of Neurosurgery;
Section of Pediatric Neurosurgery; and.
J Neurosurg Pediatr. 2015 Jul;16(1):30-5. doi: 10.3171/2014.11.PEDS14314. Epub 2015 Apr 3.
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.
关于脊髓脊膜膨出、Ⅱ型Chiari畸形（CM-II）及相关脑积水患者的睡眠呼吸暂停，现有文献较少。关于脑积水治疗或CM-II减压对睡眠卫生的影响，了解更少。本研究旨在对脊髓脊膜膨出患者的睡眠呼吸障碍进行探索性分析，并探讨神经外科治疗，特别是CM-II减压和脑积水管理对睡眠结构的影响。方法：作者对其多学科脊柱裂诊所诊治的所有患者（约435例脊髓脊膜膨出患者）进行回顾性研究，以评估1999年3月至2013年7月期间获得的多导睡眠图。他们使用描述性统计分析促使进行评估的症状、结果及推荐的干预措施。他们还对9例在神经外科干预前后均接受多导睡眠图检查的儿童进行了亚组分析。结果：52例患者有多导睡眠图可供回顾。其中81%的患者被诊断为睡眠呼吸暂停。最常见的就诊症状是“呼吸困难”（18例[43%]）。轻度睡眠呼吸暂停26例（50%），中度10例（19%），重度6例（12%）。在42例睡眠结构异常的患者中，30例主要为阻塞性呼吸暂停，12例主要为中枢性呼吸暂停。肺科最常推荐的干预措施是调整外周氧补充（24例[57%]），其次是开始外周给氧（10例[24%]）。在对9例神经外科干预前后进行睡眠研究的患者的亚组分析中，呼吸事件平均数量（从34.8降至15.9，p = 0.098）、阻塞性事件（从14.7降至13.9，p = 0.85）和中枢性事件（从20.1降至2.25，p = 0.15）以及呼吸暂停低通气指数（从5.05降至2.03，p = 0.038，经多重测量校正后无统计学意义）有下降趋势。结论：在初次研究中，很大一部分接受多导睡眠图检查脊髓脊膜膨出患者存在睡眠紊乱的证据。此外，31%的患者有中度或重度阻塞性睡眠呼吸暂停。接受外周氧补充非手术治疗的睡眠结构异常的脊髓脊膜膨出患者，其呼吸暂停低通气指数有所改善。本研究结果表明，脊髓脊膜膨出患者的多导睡眠图检查可能为检测和分类睡眠呼吸暂停、确定低风险干预措施以及预防睡眠呼吸障碍的未来影响提供机会。
