Chiari malformation type I (CM-I) involves the herniation of the cerebellar tonsils through the foramen magnum. CM-I is associated with both obstructive sleep apnea (OSA) and central sleep apnea (CSA) in children. The primary management of symptomatic CM-I remains surgical decompression. There is, however, a paucity of data evaluating the efficacy of decompression surgery on outcomes related to sleep-disordered breathing (SDB). The objective of this study was to evaluate SDB outcomes, specifically the need for respiratory support following decompression in pediatric patients with CM-I.

This was a retrospective chart review of all children diagnosed with CM-I when younger than 18 years of age who had polysomnography (PSG) studies pre- and postsurgery, between January 2008 and October 2018 at the Hospital for Sick Children in Toronto. Patient demographics, symptoms, PSG data, ongoing respiratory support, and surgical notes were recorded. Differences in PSG studies obtained pre- and postsurgery were compared using the Wilcoxon test for paired samples.

A total of 15 children with 15 interventions met inclusion criteria with pre- and postsurgery PSG studies and were considered for statistical analysis. Of the 15 subjects included for analysis, preoperative OSA was present in 2 (13.3%), CSA in 5 (33.3%), mixed SDB (both OSA and CSA) in 4 (26.7%), and no significant SDB in 4 (26.7%). Postoperatively, OSA was present in 3 (20.0%), CSA in 4 (26.7%), mixed SDB in 0 (0%), and no significant SDB in 8 (53.3%). The presence of severe OSA decreased from 4/15 (26.7%) to 2/15 (13.3%) postoperatively, and severe CSA decreased from 5/15 (33.3%) to 2/15 (13.3%) postoperatively. Following decompression surgery, 7/15 subjects (46.7%) required positive airway pressure for management of their SDB. Overall, significant improvements were observed in a number of respiratory parameters following decompression including the following: the total apnea-hypopnea index (AHI) (17.5 ± 48.2 vs 6.1 ± 32.7 events/hour; p = 0.001), obstructive AHI (2.1 ± 16.1 vs 1.0 ± 6.6 events/hour; p = 0.005), central AHI (6.3 ± 48.9 vs 2.7 ± 33.0 events/hour; p = 0.005), and the desaturation index (16.7 ± 49.6 vs 3.8 ± 25.3; p = 0.001).

Although decompression surgery led to a significant reduction in obstructive and central events, many children continued to have persistent SDB and required additional positive airway pressure therapy. This information is important and relevant for anticipatory guidance around decompression surgery and the necessity for respiratory support for the management of SDB in pediatric patients with CM-I.

Chiari 畸形 I 型 (CM-I) 涉及小脑扁桃体通过枕骨大孔突出。CM-I 与儿童阻塞性睡眠呼吸暂停 (OSA) 和中枢性睡眠呼吸暂停 (CSA) 相关。有症状的 CM-I 的主要治疗方法仍然是手术减压。然而，很少有数据评估减压手术对睡眠呼吸障碍（SDB）相关结果的疗效。本研究的目的是评估 SDB 的结果，特别是 CM-I 儿科患者减压后对呼吸支持的需求。

这是对 2008 年 1 月至 2018 年 10 月在多伦多病童医院进行手术前和手术后多导睡眠图 (PSG) 研究的所有 18 岁以下诊断为 CM-I 的儿童的回顾性图表审查。记录了患者的人口统计学、症状、PSG 数据、持续的呼吸支持和手术记录。使用配对样本的 Wilcoxon 检验比较手术前和手术后获得的 PSG 研究的差异。

共有 15 名儿童接受了 15 项干预措施，符合手术前和手术后 PSG 研究的纳入标准，并被考虑进行统计分析。在纳入分析的 15 名受试者中，2 名 (13.3%) 出现术前 OSA，5 名 (33.3%) 出现 CSA，4 名 (26.7%) 出现混合 SDB（OSA 和 CSA），4 名 (26.7 %）。术后，3 例（20.0%）存在 OSA，4 例（26.7%）存在 CSA，0 例（0%）存在混合 SDB，8 例（53.3%）无明显 SDB。术后严重 OSA 的发生率从 4/15（26.7%）减少到 2/15（13.3%），术后严重 CSA 从 5/15（33.3%）减少到 2/15（13.3%）。减压手术后，7/15 受试者 (46.7%) 需要气道正压来管理他们的 SDB。全面的，

尽管减压手术显着减少了阻塞性和中枢性事件，但许多儿童仍持续存在 SDB，需要额外的气道正压治疗。该信息对于关于减压手术的预期指导以及对 CM-I 儿科患者的 SDB 管理的呼吸支持的必要性非常重要且相关。