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Abstract
Introduction Central sleep apnoea (CSA) is an uncommon paediatric syndrome characterised by recurrent cessations of ventilatory effort related to a lack of central drive to breathe during sleep. Literature describing the expected clinical course of CSA is limited and there are no guidelines on appropriate management. The study aimed to follow children with CSA from presentation to final outcome and investigate the factors associated with the choices for management of these patients.
Methods A retrospective analysis of medical records of children with CSA seen at Sheffield Children’s Hospital (SCH) over 10 years was conducted (n=30). Children with a diagnosis of CSA or polysomnography (PSG) findings that would be classified as CSA under current practices (an apnoea-hypopnoea index (AHI) of ≥5/hour or significant physiologic changes related to central apnoeas) were eligible for inclusion. Data was collected on demographics, co-morbidities, presentation, clinical events, diagnosis, investigations (including PSG and oximetry results), management (figure 1), factors related to management choices, and outcomes.
Results 43.3% presented with a ‘brief resolved unexplained event’ (11 resuscitated). The most common age at presentation was 8-weeks (n=8). 20% were being safeguarded. The most common co-morbidities (n=9) were reflux and heart murmurs. The number of central apnoeas, AHI, and 3% desaturation index were shown to significantly improve from the first to last PSG (&xbar; improvement=15.42, p=0.000; &xbar; improvement=15.80, p=0.002; &xbar; improvement=15.82, p=0.005 respectively) (figure 2). 8/30 patients were discharged from the sleep service (1/8 deceased due to CSA). Children with parents reported to be anxious remained in the service for significantly longer than children without (x2=3.855, p=0.05).
Bar chart showing the frequency of different managements seen in children with CSA at SCH
Number of central apnoeas recorded on PSG over time for each child with CSA seen at SCH, demonstrating a mean decrease of 15.42 central apnoeas from first to last PSG (p=0.000)
Discussion PSG results demonstrated that this is a significant syndrome with risk of mortality, however the natural clinical course of paediatric CSA is improvement with time. Parental anxiety significantly increases the length of management time. This is the first study to document the death of a child primarily due to CSA.
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