{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:47:13Z","timestamp":1789670833648,"version":"4.0.1"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The objective was to identify clinical and radiological factors associated with sleep-disordered breathing (SDB) in children with Chiari type I malformation (CIM) and to evaluate the efficacy of foramen magnum decompression (FMD) in resolving SDB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective chart review was conducted for all children evaluated for CIM at a single institution from 2002 to 2022, identifying all children who had undergone nocturnal polysomnography (PSG). Apnea-hypopnea index (AHI) score, sleep apnea type (obstructive, central, mixed, and unspecified), clinical manifestations, and radiological measurements were recorded. SDB was considered present when officially diagnosed in the PSG report. Logistic regression was performed to identify factors correlating with the presence of SDB. For children with SDB who underwent FMD, the Wilcoxon signed-rank test was used to assess AHI improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of the 997 children referred for CIM, 310 completed PSG. SDB was diagnosed in 147 patients (overall prevalence 14.7%, 95% CI 12.7%\u201317.1%; prevalence among children with PSG 47.4%, 95% CI 41.9%\u201353%). Specific SDB diagnosis consisted of 33% of patients with central sleep apnea, 27% with obstructive sleep apnea, 9% mixed, and 31% unspecified. Lower cranial nerve (CN) dysfunction (OR 3.891, p = 0.009), tonsillar position (OR 1.049, p = 0.017), Chiari type 1.5 malformation (OR 1.862, p = 0.044), and BMI (OR 1.039, p = 0.036) were significantly associated with presence of SDB. Of the 310 patients who underwent PSG, 47 were originally categorized as asymptomatic: 27 (57%) of these asymptomatic patients were diagnosed with SDB on PSG. Of children diagnosed with SDB, 34 completed PSG before and after FMD. Median AHI score decreased from 6.5 preoperatively to 1.8 postoperatively, with a median (IQR) difference of \u22122.3 (\u221211.9 to 0.1) (p = 0.001). Twelve (35%) had resolution of SDB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The authors\u2019 findings suggest that the prevalence of SDB in children with CIM is high (15%\u201347%). Furthermore, lower CN dysfunction, Chiari type 1.5, lower tonsillar position, and higher BMI may be risk factors. Notably, SDB can be present even in the absence of clinical symptoms. This study also demonstrates that surgical intervention has the potential to reduce the severity of SDB. These results could help clinicians identify CIM patients at risk for SDB and those who may benefit from surgical decompression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.5.peds24105","type":"journal-article","created":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T22:11:20Z","timestamp":1720822280000},"page":"393-401","source":"Crossref","is-referenced-by-count":6,"title":["Sleep-disordered breathing in children with Chiari type I malformation"],"prefix":"10.3171","volume":"34","author":[{"given":"Matthew","family":"Jarrell","sequence":"first","affiliation":[{"name":"University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Caudill","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faizal","family":"Haji","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tofey","family":"Leon","sequence":"additional","affiliation":[{"name":"Ascension St. Vincent\u2019s, Vestavia Hills, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Curtis J.","family":"Rozzelle","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Halsey","family":"Maddox","sequence":"additional","affiliation":[{"name":"Pediatrics, University of Alabama at Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon G.","family":"Rocque","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"Suppl 1","key":"b1","series-title":"BMC Musculoskelet Disord","first-page":"S1","article-title":"Malformations of the craniocervical junction (Chiari type I and syringomyelia: classification, diagnosis and treatment)","volume":"10","author":"Fernandez AA","year":"2009","unstructured":"Fernandez AA, Guerrero AI, Martinez MI,  Malformations of the craniocervical junction (Chiari type I and syringomyelia: classification, diagnosis and treatment). BMC Musculoskelet Disord. 2009;10(Suppl 1):S1."},{"issue":"2","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"205","article-title":"Chiari malformation Type I and syrinx in children undergoing magnetic resonance imaging","volume":"8","author":"Strahle J","year":"2011","unstructured":"Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJ, Maher CO. Chiari malformation Type I and syrinx in children undergoing magnetic resonance imaging. J Neurosurg Pediatr. 2011;8(2):205\u2013213."},{"issue":"3","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"248","article-title":"Institutional experience with 500 cases of surgically treated pediatric Chiari malformation Type I","volume":"7","author":"Tubbs RS","year":"2011","unstructured":"Tubbs RS, Beckman J, Naftel RP,  Institutional experience with 500 cases of surgically treated pediatric Chiari malformation Type I. 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Can Respir J. 2015;22(1):31\u201336."},{"issue":"12","key":"b6","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1344","article-title":"Chiari malformation and sleep related breathing disorders","volume":"78","author":"Dauvilliers Y","year":"2007","unstructured":"Dauvilliers Y, Stal V, Abril B,  Chiari malformation and sleep related breathing disorders. J Neurol Neurosurg Psychiatry. 2007;78(12):1344\u20131348."},{"issue":"3","key":"b7","series-title":"Pediatrics","first-page":"e714","article-title":"Diagnosis and management of childhood obstructive sleep apnea syndrome","volume":"130","author":"Marcus CL","year":"2012","unstructured":"Marcus CL, Brooks LJ, Draper KA,  Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):e714\u2013e755."},{"key":"b8","series-title":"Paediatr Respir Rev","first-page":"49","article-title":"Diagnosis, management and pathophysiology of central sleep apnea in children","volume":"30","author":"McLaren AT","year":"2019","unstructured":"McLaren AT, Bin-Hasan S, Narang I. Diagnosis, management and pathophysiology of central sleep apnea in children. Paediatr Respir Rev. 2019;30:49\u201357."},{"issue":"2","key":"b9","series-title":"Intensive Care Med","first-page":"73","article-title":"Sudden death revealing Chiari type 1 malformation in two children","volume":"19","author":"Martinot A","year":"1993","unstructured":"Martinot A, Hue V, Leclerc F, Vallee L, Closset M, Pruvo JP. Sudden death revealing Chiari type 1 malformation in two children. Intensive Care Med. 1993;19(2):73\u201374."},{"issue":"2 Suppl","key":"b10","series-title":"J Neurosurg","first-page":"179","article-title":"A critical analysis of the Chiari 1.5 malformation","volume":"101","author":"Tubbs RS","year":"2004","unstructured":"Tubbs RS, Iskandar BJ, Bartolucci AA, Oakes WJ. A critical analysis of the Chiari 1.5 malformation. J Neurosurg. 2004;101(2 Suppl):179\u2013183."},{"issue":"4","key":"b11","series-title":"J Neurosurg Pediatr","first-page":"452","article-title":"The relationship between Chiari 1.5 malformation and sleep-related breathing disorders on polysomnography","volume":"27","author":"Sader N","year":"2021","unstructured":"Sader N, Hader W, Hockley A, Kirk V, Adeleye A, Riva-Cambrin J. The relationship between Chiari 1.5 malformation and sleep-related breathing disorders on polysomnography. J Neurosurg Pediatr. 2021;27(4):452\u2013458."},{"issue":"5","key":"b12","series-title":"Chest","first-page":"1346","article-title":"Sleep-related breathing disorders and the Chiari 1 malformation","volume":"148","author":"Leu RM","year":"2015","unstructured":"Leu RM. Sleep-related breathing disorders and the Chiari 1 malformation. Chest. 2015;148(5):1346\u20131352."},{"issue":"6","key":"b13","series-title":"J Neurosurg Pediatr","first-page":"611","article-title":"The efficacy of neurosurgical intervention on sleep-disordered breathing in pediatric patients with Chiari malformation type I","volume":"27","author":"Voutsas G","year":"2021","unstructured":"Voutsas G, St-Laurent A, Hutchinson C, Amin R, Drake J, Narang I. The efficacy of neurosurgical intervention on sleep-disordered breathing in pediatric patients with Chiari malformation type I. 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Neurosurgery. 2019;85(6):854\u2013860."},{"issue":"5","key":"b16","series-title":"Pediatr Neurosurg","first-page":"245","article-title":"Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus","volume":"29","author":"O\u2019Hayon BB","year":"1998","unstructured":"O\u2019Hayon BB, Drake JM, Ossip MG, Tuli S, Clarke M. Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg. 1998;29(5):245\u2013249."},{"key":"b17","article-title":"National Institute of Neurological Disorders and Stroke","unstructured":"Chiari I Malformation Imaging. National Institute of Neurological Disorders and Stroke. 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