Obstructive sleep apnea syndrome as a rare presentation in a young girl with a central nervous system tumor

Abstract

Sleep-related breathing disorders are a common problem in infancy and childhood. The most common type of sleep-related breathing disorder in this age group is obstructive sleep apnea syndrome (OSAS), generally caused by factors affecting airway patency, such as tonsillar hypertrophy or obesity. However, in adults OSAS can also be caused by processes affecting the brainstem, such as central nervous system tumors. This report describes a 2-year-old girl who presented with symptoms of snoring, restless sleep, repeated night-time waking, and apneic events while asleep. She had no comorbidities, and examination revealed normal-sized tonsils. A sleep study demonstrated severe OSAS with an obstructive apnea/hypopnea index of 34. Her OSAS completely resolved on excision of the tumor. The case highlights the importance of neurological examination as part of evaluation of OSAS, especially in cases where tonsils are not enlarged and there are no other risk factors for OSAS.

Citation: Buller F, Kamal MA, Brown SK, et al. Obstructive sleep apnea syndrome as a rare presentation in a young girl with a central nervous system tumor. J Clin Sleep Med. 2022;18(4):1211-1214.

Keywords: brain tumor; obstructive sleep apnea syndrome; sleep-disordered breathing.

Figure 1. Pre- and postoperative sleep study results.

Screenshots of overnight SpO₂ profile over 11 hours (A) and a 2-minute sleep epoch (B) demonstrating obstructive events. Screenshots of overnight SpO2 profile over 11 hours (C) and a 2-minute sleep epoch (D) demonstrating complete resolution of obstructive events. The SOMNOtouch device includes a nasal cannula which monitors respiratory flow and snore signals; in this case there was extensive mouth breathing, which limited the utility of this channel.

Figure 2. Pre- and postoperative MRI scans of the brain.

Preoperative sagittal (A) and axial (B) scans showing a mixed solid cystic lesion within the posterior fossa and effacement of the fourth ventricle. Postoperative sagittal (C) and axial (D) scans showing increased enhancement within the resection cavity with no definite evidence of disease recurrence.