A prospective controlled study of sleep respiratory events in patients with craniovertebral junction malformation.
OBJECTIVE
Craniovertebral junction malformation (CVJM) or Chiari malformation in adults, with or without syringomyelia and basilar invagination, produces neuronal dysfunction of the brainstem, cerebellum, cranial nerves, and upper spinal cord. The respiratory center and some of its afferent and efferent components can be altered in these diseases. The authors studied patients with and without CVJM to determine whether this physical feature contributed to sleep disturbances.


METHODS
Respiratory manifestations during sleep were studied prospectively, by using whole-night polysomnography, in 32 symptomatic patients (CVJM group) and 16 healthy volunteers (control group). Patients with CVJM presented with more sleep disturbances (reports of snoring and apnea) than those in the control group. The apnea/hypopnea index values were higher in patients with CVJMs than in the control group (13 +/- 15 compared with 3 +/- 6; p = 0.007) and the rate of central sleep apneas was higher in the CVJM than in the control group (22 +/- 30 compared with 4 +/- 8%; p = 0.009). The apnea/hypopnea index was highest in the subgroup with basilar invagination than in the other subgroups. The central apneic episodes were more frequent in the patients with basilar invagination (35 +/- 40%; p = 0.001) and in those with syringomyelia (17.6 +/- 24.6%; p = 0.003) than in the control group (4 +/- 8%). Patients with symptomatic CVJM, especially those with basilar invagination, presented with more sleep respiratory compromise than did those in the control group.


CONCLUSIONS
The incidence of sleep apnea/hypopnea syndrome is significantly higher in patients with CVJM.
Botelho
Ricardo Vieira
RV
Department of Psychobiology, Sleep Institute, Universidade Federal de São Paulo, São Paulo, Brazil. bitbot@uol.com.br
Bittencourt
Lia Rita Azeredo
LR
Rotta
José Marcos
JM
Tufik
Sergio
S
D000328:Adult; D000368:Aged; D001139:Arnold-Chiari Malformation / Q000150:complications* / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010985:Platybasia / Q000150:complications / Q000473:pathology; D017286:Polysomnography; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D013595:Syringomyelia / Q000150:complications / Q000473:pathology