Hypercarbic periodic breathing during sleep in a child with a central nervous system tumor.
A 4-yr-old girl with a ganglioglioma involving the cerebellum and pons presented with CO2 retention and arterial O2 desaturation during wakefulness and sleep. Despite the presence of a regular respiratory pattern during wakefulness, NREM sleep was associated with the appearance of a sustained periodic respiratory pattern characterized by clusters of usually two breaths separated by an 8 to 10-s expiratory pause. At sleep onset, this Biot's respiratory pattern appeared immediately after a sigh. Breathing frequency during NREM sleep became regular with administration of supplemental O2 and an attendant increase in end-tidal CO2. Shortly after withdrawal of supplemental O2 during NREM sleep, the periodic pattern resumed and was again immediately preceded by a sigh. The observations during NREM sleep in this patient with a central nervous system abnormality indicate that Biot's type respiratory pattern may be reversed by administration of supplemental oxygen. The results in this patient suggest: (1) the presence of a very elevated CO2 apnea threshold, and (2) that the pons may play a role in determining the effect of hypercapnic hypoxia on respiratory pattern during sleep.
Kuna
S T
ST
Department of Internal Medicine, University of Texas Medical Branch, Galveston 77550-2778.
Smickley
J S
JS
Murchison
L C
LC
D001932:Brain Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002245:Carbon Dioxide / Q000097:blood* / Q000502:physiology; D002528:Cerebellar Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D009447:Neuroblastoma / Q000150:complications* / Q000000981:diagnostic imaging; D010100:Oxygen / Q000097:blood; D011149:Pons; D012119:Respiration / Q000502:physiology; D012120:Respiration Disorders / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D012890:Sleep / Q000502:physiology*; D014057:Tomography, X-Ray Computed
D002245:Carbon Dioxide; D010100:Oxygen