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.