Case Study: Central Sleep Apnea Syndrome

The patient: 8-year-old boy

Presented with: Snoring, frequent headaches, occasional outbursts The patient had been snoring since age 2. A previous adenoidectomy and tonsillectomy did not help the patient’s snoring problems. The patient also had severe headaches, which would occasionally cause him to grab the back of his neck in pain. “I couldn’t even go through gym class without getting a headache,” the patient says. He also had brief temper tantrums, usually for an hour or so after he got home from school in the afternoon. “He was just exhausted and in pain,” the patient’s mother says.

Evaluated by: Board-certified pediatric sleep specialist Pearl Yu, M.D. “Basically, he had several issues with his sleep,” Yu says. The patient continually became fatigued in the early afternoon, and he moved between being tired and hyperactive. Believing the patient was getting was getting non-restorative sleep caused by obstructive sleep apnea, Yu ordered a sleep study at the Pediatric Sleep Disorders Center at UVA Children’s Hospital.

Diagnosis: Central Sleep Apnea Syndrome and Chiari Type I malformation Surprisingly, the sleep study revealed that the patient had central sleep apnea syndrome with no evidence of obstructive sleep apnea syndrome. Central sleep apnea syndrome is a condition where a patient will take three to four breaths, then stop breathing for 20 to 40 seconds. The sleep study revealed the patient had 214 central sleep apneas during the study. Because the patient had central sleep apnea – not the more common obstructive sleep apnea – Yu recommended the patient undergo a brainstem MRI, which revealed the Chiari Type I malformation, a malformation that occurs when the cerebellar tonsils pass through the foramen magnum along with the spinal cord.

Treatment: Surgery and insertion of a shunt The patient underwent a series of four decompression surgeries performed by UVA pediatric neurosurgeon John Jane Jr., M.D. He also had a brain shunt installed to treat hydrocephalus that developed as a result of the Chiari malformation.

Outcome: Improved sleep and mood, significantly fewer headaches Months after the surgeries, the patient’s mother says, “I could see a difference in his behavior. He wasn’t hyper from not getting enough sleep. Today, he has occasional headaches, but compared to where he was four years ago – in a lot of constant pain – he’s much better now.”

“I feel stronger, I feel like I’m more rested, and I just feel happier,” the patient says.

The patient’s mother greatly appreciates the treatment team at UVA Children’s Hospital. “With Dr. Yu’s help, we were able to narrow down what was wrong so we didn’t lose our son in the middle of the night,” she says. “And Dr. Jane did a great job with the surgeries.”

To refer a patient to UVA’s Pediatric Sleep Disorders program, call UVA Physician Direct at 800.552.3723 .