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A1989 - Clinical Characteristics of Central Sleep Apnea in Children Older than 2 Years of Age
Author Block: S. Hantragool1, J. A. Torres Garcia2, N. Gurbani1, N. Simakajornboon1; 1Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States, 2Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Introduction: Clinical characteristics of central sleep apnea (CSA) is very limited in children compared to the adult population. Our recent study has shown that infants with CSA often has co-existing obstructive sleep apnea suggesting the important role of high loop gain and sleep instability. The purpose of our study is to describe clinical presentations, diagnostic findings, and polysomnographic results found in children beyond 2 years old with CSA. Methods: A retrospective review of medical records and polysomnograms was conducted in pediatric patients with CSA from Cincinnati Children’s Hospital Medical Center who were between 2-20 years old at the time diagnosis. CSA was defined as central apnea index > 5 events/hour. Patients with ventilator, tracheostomy and incomplete records were excluded. Results: 122 subjects met the criteria for entry into analysis. The mean age at diagnosis was 7.7 + 5.4 years, with a mean BMI of 22.6 + 9.74, 51% was male. Common presentations included snoring (65%), apnea (41%), restless sleep (33%), daytime sleepiness (32%), and gasping (30%). Other associated conditions included prematurity (25%), difficulty feeding (17%) and gastroesophageal reflux (12%). The mean apnea-hypopnea index (AHI) was 29.4 + 37.7/hr, the mean central-apnea index was 17.7 + 31.6/hr and the mean obstructive index was 10.8 + 17.7. 40% had significant obstructive sleep apnea (AHI > 5/hr). The mean percentage of periodic breathing was 3.2 + 8.1%. For diagnostic evaluations, 30% had abnormal brain MRI, 23% had abnormal EEG, 18% had upper airway abnormalities, 5% had abnormal metabolic profile and 1.6% had abnormal thyroid function test. The comorbidities included neurologic diseases (47%, 5% with Chiari malformation), upper airway obstruction (41%), obesity (28%), genetic diseases (24%), gastroesophageal reflux diseases and aspiration (23%), cardiac diseases (8%) and hypothyroidism (1.6%). In our study, 5 patients (4%) met the criteria of idiopathic CSA. Conclusion: Children with central sleep apnea often present with significant sleep complaints including snoring, apnea, restless sleep and daytime sleepiness. Most children have co-existing obstructive sleep apnea similar to infancy group. Neurologic diseases are the most common comorbidity in our study population, followed by upper airway obstruction. Idiopathic CSA is quite rare in children. Further studies are needed to asses if respiratory instability (high loop gain) plays an important role in CSA in this age group.