title: Is MRI Necessary in the Evaluation of Pediatric Central Sleep Apnea?
abstract: OBJECTIVE
  (1) To determine the prevalence of central nervous system (CNS) pathology identified on head magnetic resonance imaging (MRI) scans in children with central sleep apnea (CSA); (2) to assess the yield of MRI in evaluation of CSA; and (3) to identify factors that predict CNS pathology in children with CSA.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary children's hospital.
  
  
  METHODS
  A chart review was conducted over 12 years. Patients 6 months to 18 years of age who underwent head MRI for evaluation of CSA were included. CSA was diagnosed on polysomnogram as central apnea index >1.
  
  
  RESULTS
  Forty children were included in the CSA group. Twenty-two patients were male, and the mean age was 60 ± 41.5 months. The mean central apnea index was 3.8 ± 1.9, while the mean obstructive apnea hypopnea index was 3.4 (interquartile range, 0.7-3.8). Eighteen percent (7 of 40) of children with CSA had evidence of CNS pathology on MRI, with the most common finding (n = 3) being arachnoid cyst. Children with CSA who had gastroesophageal reflux disease or abnormal neurologic examinations were more likely to have CNS pathology. Other factors, such as prematurity, did not improve the yield of MRI in children with CSA.
  
  
  CONCLUSIONS
  While routine evaluation of children with elevated central apnea index by MRI is not indicated, providers should consider neuroimaging in children with CSA and abnormal neurologic examination findings or gastroesophageal reflux disease. Further research is necessary to identify other tests with improved diagnostic yield for evaluation of pediatric CSA.
authors.affiliation: Eastern Virginia Medical School, Norfolk, Virginia, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Woughter
authors.affiliation: Department of Pediatrics, Division of Biostatistics and Innovation in Research Design, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia, USA.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Perkins
authors.affiliation: Department of Otolaryngology, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA baldassc@gmail.com cristina.baldassari@chkd.org.
authors.forename: Cristina M
authors.initials: CM
authors.lastname: Baldassari
mesh_terms: D000293:Adolescent; D016080:Arachnoid Cysts / Q000473:pathology; D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006257:Head; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D017286:Polysomnography; D020182:Sleep Apnea, Central / Q000473:pathology*
keywords: Chiari malformation; pediatric; polysomnogram; sleep apnea