Utility of MRI in Workup of Pediatric Central Sleep Apnea

Abstract

Objective: 1) To determine the incidence of central nervous system pathology on magnetic resonance imaging (MRI) scans in children with central sleep apnea (CSA). 2) To assess whether certain factors such as abnormalities on neurologic examination impact the yield of MRI in evaluation of CSA.

Method: A retrospective chart review was conducted at a tertiary pediatric hospital over 10 years. Inclusion criteria were patients 6 months to 18 years of age who underwent both full-night polysomnogram (PSG) and head MRI. Children with central apnea index (CAI) greater than 1 were considered to have CSA.

Results: Thirty-six children were included. Sixteen patients were boy (44.4%), and the mean age was 43.2 ± 52.2 months. Twenty children (55.6%) had CAI greater than 1. Fourteen children (38.9%) had evidence of pathology on MRI, with the most common finding (n = 5) being arachnoid cyst. When patients with CSA were compared to those without CSA, there was no significant difference (P = .23) in rates of abnormal head MRI. The presence of OSA on PSG did not predict (P = .54) pathologic findings on MRI. In CSA patients, the presence of either developmental delay or an abnormal neurologic exam improved the diagnostic yield of MRI.

Conclusion: CAI greater than 1 did not predict the presence of pathology on head MRI. Thus, the routine use of MRI in evaluation of CSA is not recommended. Further research is necessary to determine if there are other diagnostic tests that can be utilized in evaluation and management of pediatric CSA.