title: Sleep disordered breathing in children and adolescents with Chiari malformation type I.
abstract: OBJECTIVE
  Chiari malformation Type I (CM-I) has been associated with sleep disordered breathing (SDB). The aim of this study was to evaluate the prevalence of SDB in CM-I and its clinical correlates in a population of children and adolescents.
  
  
  METHODS
  Fifty-three consecutive children and adolescents affected by CM-I were enrolled (27 girls and 26 boys, mean age 10.3 ± 4.3, range: 3-18 years). All patients underwent neurological examination, MRI, and polysomnography (PSG). Otorhinolaryngologic clinical evaluation was performed in patients with polysomnographic evidence of sleep-related upper airway obstruction.
  
  
  RESULTS
  Mean size of the herniation was 9.5 ± 5.4 mm. Fourteen patients had syringomyelia, 5 had hydrocephalus, 31 presented neurological signs, 14 had epileptic seizures, and 7 reported poor sleep. PSG revealed SDB in 13 subjects. Patients with SDB, compared to those without SDB, had a higher prevalence hydrocephalus (p = 0.002), syringomyelia (p = 0.001), and neurological symptoms (p = 0.028). No significant difference was observed in age, gender, prevalence of epilepsy, and size of the herniation. Obstructive SDB was associated with syringomyelia (p = 0.004), whereas central SDB was associated with hydrocephalus (p = 0.034).
  
  
  CONCLUSIONS
  In our population of CM-I patients the prevalence of SDB was 24%, lower than that reported in literature. Moreover, our findings suggest that abnormalities in cerebrospinal fluid dynamics in CM-I, particularly syringomyelia and hydro-cephalus, are associated with SDB.
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy. annalosurdo@hotmail.it
authors.forename: Anna
authors.initials: A
authors.lastname: Losurdo
authors.forename: Serena
authors.initials: S
authors.lastname: Dittoni
authors.forename: Elisa
authors.initials: E
authors.lastname: Testani
authors.forename: Chiara
authors.initials: C
authors.lastname: Di Blasi
authors.forename: Emanuele
authors.initials: E
authors.lastname: Scarano
authors.forename: Paolo
authors.initials: P
authors.lastname: Mariotti
authors.forename: Giovanna
authors.initials: G
authors.lastname: Paternoster
authors.forename: Concezio
authors.initials: C
authors.lastname: Di Rocco
authors.forename: Luca
authors.initials: L
authors.lastname: Massimi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Della Marca
mesh_terms: D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography / Q000379:methods; D015995:Prevalence; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*
keywords: Chiari malformation; central sleep apnea; hydrocephalus; obstructive sleep apnea; polysomnography; sleep disordered breathing; syringomyelia.