Resolution of obstructive sleep apnea syndrome after adenoidectomy in congenital central hypoventilation syndrome

We report on a 2 1/2-year-old boy who is currently ventilated at home by po sitive pressure ventilation through a nasal mask during the night because o f congenital central hypoventilation syndrome (CCHS). Up to age 2 he had de veloped normally. A reevalution was performed because of symptoms suggestiv e of obstructive sleep apnea syndrome (OSAS), including snoring, nocturnal sweating, frequent nighttime awakenings, speech impairment, daytime fatigue , and failure to thrive. A sleep study indicated obstructive apnea episodes lasting up to 40 s and arterial desaturations below 50% during spontaneous sleep. During mechanical ventilation snoring persisted, and capillary PCO2 rose to 60 mm Hg. Partial upper airway obstruction, leaking around the mas k, and arousal movements developed on passive flexion of the neck to 20 deg rees. After adenoidectomy, symptoms of OSAS resolved. There were no more ob structive apneas during spontaneous sleep, but obstructive apneas could be provoked by neck flexion to 20 degrees. During ventilation, neck flexion of 20 degrees was tolerated, but a 40 degrees flexion led to partial obstruct ion. In CCHS patients, the problem of upper airway obstruction is rarely no ted because most patients are ventilated through a permanent tracheostomy. Today, noninvasive ventilation strategies are becoming more common. Reduced activity of upper airway muscles and impaired reflex mechanisms could lead to upper airway obstruction during face mask positive pressure ventilation in children with CCHS. Enlarged adenoids worsened this problem in our pati ent, leading to insufficient Ventilation and OSAS. Adenoidectomy resolved s ymptoms of OSAS and enabled successful nasal mask ventilation. Close follow -up of the patient avoided hypoxia and sequelae from OSAS such as pulmonary hypertension. (C) 19999 Wiley-Liss, Inc.