Department of Neurology, Boston Children's Hospital and Harvard School of Medicine, Boston, Massachusetts.
Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
J Clin Sleep Med. 2021 Jul 1;17(7):1411-1421. doi: 10.5664/jcsm.9210.
Evaluation of elevated central apnea-hypopnea index (CAHI) or prolonged central apneas in pediatric patients typically includes neuroimaging with a focus on brainstem pathology. There is little evidence guiding thresholds of polysomnographic variables that accurately predict abnormal neuroimaging. We sought to evaluate whether additional polysomnographic variables may help predict brainstem pathology.
A 10-year retrospective review of patients ages 1-18 years who received a brain magnetic resonance imaging (MRI) for an indication of central sleep apnea diagnosed via polysomnography was performed. Demographics, medical history, polysomnogram variables, and MRI results were compared.
This study included 65 patients (69.2% male). The median age was 5.8 years (interquartile range, 3.0-8.3). Most patients had negative (normal or nonsignificant) MRIs (n = 45, 69.2%); 20 (30.8%) had abnormal MRIs. Of the patients with abnormal MRIs, 13 (20.0%) had abnormalities unrelated to the brainstem. Seven patients (10.8%) were found to have brainstem pathology and had a median CAHI of 10.8 events/h (interquartile range, 6.5-21.9), and three of seven (42.9%) had hypoventilation and were more likely to have developmental delay, abnormal neurological examinations, and reflux. Other patients (n = 58) had a median CAHI of 5.6 events/h (interquartile range, 3.1-9.1), and seven (12.1%) had hypoventilation. Area under the curve and receiver operating characteristic curves showed a CAHI ≥ 9.5 events/h and ≥ 6.4% of total sleep time with end-tidal CO₂ ≥ 50 mm Hg predicted abnormal brainstem imaging. Prolonged central apneas did not predict abnormal brainstem imaging.
Most patients with central sleep apnea do not have MRIs implicating structurally abnormal brainstems. Utilizing a cutoff of CAHI of ≥ 9.5 events/h, ≥ 6.4% total sleep time with end-tidal CO₂ ≥ 50 mm Hg and/or frank hypoventilation, and additional clinical history may optimize MRI utilization in patients with central sleep apnea.
评估儿科患者的中枢性呼吸暂停-低通气指数（CAHI）升高或中枢性呼吸暂停时间延长通常包括针对脑干病理的神经影像学检查。指导准确预测异常神经影像学的多导睡眠图变量阈值的证据很少。我们试图评估其他多导睡眠图变量是否有助于预测脑干病理。
对因中枢性睡眠呼吸暂停通过多导睡眠图诊断而行脑磁共振成像（MRI）检查的 1-18 岁患者进行了一项为期 10 年的回顾性研究。比较了患者的人口统计学资料、病史、多导睡眠图变量和 MRI 结果。
本研究纳入了 65 名患者（69.2%为男性）。中位年龄为 5.8 岁（四分位间距，3.0-8.3）。大多数患者的 MRI 结果为阴性（正常或无显著异常）（n=45，69.2%）；20 名（30.8%）患者的 MRI 异常。MRI 异常的患者中，有 13 名（20.0%）的异常与脑干无关。7 名（10.8%）患者被发现有脑干病变，其 CAHI 中位数为 10.8 次/小时（四分位间距，6.5-21.9），7 名中有 3 名（42.9%）有通气不足，更可能有发育迟缓、异常的神经系统检查和反流。其他患者（n=58）的 CAHI 中位数为 5.6 次/小时（四分位间距，3.1-9.1），7 名（12.1%）有通气不足。曲线下面积和受试者工作特征曲线显示，CAHI≥9.5 次/小时和总睡眠时间≥6.4%，且呼气末二氧化碳≥50mmHg 预测异常脑干成像。延长的中枢性呼吸暂停并不能预测异常的脑干成像。
大多数患有中枢性睡眠呼吸暂停的患者的 MRI 均未显示结构异常的脑干。利用 CAHI≥9.5 次/小时、总睡眠时间≥6.4%，呼气末二氧化碳≥50mmHg 和/或明显通气不足的截断值，以及其他临床病史，可能优化中枢性睡眠呼吸暂停患者的 MRI 应用。
