Two girls with central sleep apnea syndrome diagnosed by polysomnography

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  • 睡眠ポリグラフ（PSG）にて中枢性睡眠時無呼吸症候群と判明した女児 2 症例
  • —PSG を行うべき症例とは—

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  Polysomnography (PSG) is the gold standard for evaluating pediatric sleep disordered breathing. I report two pediatric cases diagnosed as central sleep apnea syndrome by PSG. Case 1 was a 10-year-old girl with witnessed snoring and apnea. She occasionally complained of headaches. Tonsil hypertrophy and adenoid hypertrophy were confirmed. Home cardiorespiratory monitoring showed one-hour continuous intermittent oxygen desaturation after the onset of sleep. Case 2 was an 11-year-old girl with recurrent snoring after an adenotonsillectomy at the age of four. She was obese and showed hypertrichosis. Home cardiorespiratory monitoring showed a high pulse rate and intermittent desaturation without a rising pulse rate. Obstructive sleep apnea syndrome was suspected in both cases, but PSG revealed that almost all respiratory events were central apnea. The total apnea hypopnea indices were 18.6/h in case 1 and 26.6/h in case 2. Because the cranial MRI indicated herniation of the cerebellar tonsils through the foramen magnum, Case 1 was diagnosed as a type I Chiari malformation. The parents of Case 2 refused further medical examination, and therefore the cause of the central apnea was unidentified.<br/>  At the Pediatric Sleep Related Disorders Clinic, medical conditions associated with sleep-disordered breathing are occasionally not recognized. We should perform PSG for pediatric cases with a suspicion of specific medical condition and/or co-morbid disease. Moreover, in cases with atypical patterns in cardiorespiratory monitoring, careful examinations including PSG are required.

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