Ferré Álex, Poca Maria A, de la Calzada Maria D, Moncho Dulce, Romero Odile, Sampol Gabriel, Sahuquillo Juan
Clinical Neurophysiology Department, Barcelona, Spain.
Multidisciplinary Sleep Unit, Barcelona, Spain.
Sleep. 2017 Jun 1;40(6). doi: 10.1093/sleep/zsx069.
The aim of the present study is to describe the prevalence of sleep disorders in a large group of patients with Chiari malformation type 1 (CM-1) and determine the presence of risk factors associated with these abnormalities.
Prospective study with consecutive patient selection. We included 90 adult patients with CM-1, defined by the presence of a cerebellar tonsillar descent (TD) ≥3 mm. Clinical, neuroradiological studies, and nocturnal polysomnography (PSG) was carried out. In addition, patients were also subclassified into 2 CM subtypes: CM-1, with the obex above the foramen magnum (FM) and CM-1.5, in which along with a TD ≥3 mm, the obex was located below the FM.
We observed a high prevalence (50%) of sleep-related breathing disorders (SRBDs) with predominant hypopnea. Only six patients showed a central apnea index of ≥5. Hypoventilation was observed in only three patients. SRBD severity was associated with male sex, older age, excess weight, and the presence of hydrocephalus. No differences in clinical or PSG parameters were found when comparing CM subtypes (CM-1 and CM-1.5). Sleep architecture study showed decreased sleep efficiency with an increase in arousal and waking after sleep onset. The presence of SRBDs was found to be associated with poorer sleep architecture parameters.
This study confirms a high prevalence of SRBDs in patients with CM-1 and CM-1.5, with a predominant obstructive component. Nocturnal PSG recordings should be systematically conducted in these patients, especially those who are male, older, or overweight or those who present hydrocephalus.
本研究旨在描述一大组1型Chiari畸形（CM - 1）患者睡眠障碍的患病率，并确定与这些异常相关的危险因素。
采用连续病例选择的前瞻性研究。我们纳入了90例成年CM - 1患者，通过小脑扁桃体下疝（TD）≥3 mm来定义。进行了临床、神经放射学研究及夜间多导睡眠图（PSG）检查。此外，患者还被分为2种CM亚型：CM - 1，延髓位于枕骨大孔（FM）上方；CM - 1.5，除TD≥3 mm外，延髓位于FM下方。
我们观察到睡眠相关呼吸障碍（SRBDs）的患病率较高（50%），主要为呼吸浅慢。仅6例患者的中枢性呼吸暂停指数≥5。仅3例患者观察到通气不足。SRBDs的严重程度与男性、年龄较大、超重及脑积水的存在有关。比较CM亚型（CM - 1和CM - 1.5）时，临床或PSG参数未发现差异。睡眠结构研究显示睡眠效率降低，睡眠开始后觉醒和清醒增加。发现SRBDs的存在与较差的睡眠结构参数相关。
本研究证实CM - 1和CM - 1.5患者中SRBDs的患病率较高，主要为阻塞性成分。这些患者应系统地进行夜间PSG记录，尤其是男性、年龄较大、超重或患有脑积水的患者。
