585 - Outcomes of Treatment for Sleep Disordered Breathing in Children with Spina Bifida

Data is limited on the effectiveness of treatments (e.g., tonsillectomy) for sleep disordered breathing (SDB) in individuals with spina bifida (SB). The impact of common clinical procedures (e.g., shunt placement) on SDB treatment response in children with SB is unknown.

Objective:

This study aimed to determine the impact of SDB treatments and SB-related procedures on the change in apnea-hypopnea index (AHI) and obstructive index (OI) in individuals with SB.

Design/Methods:

A retrospective database analysis and chart review was conducted for patients with myelomeningocele and a diagnosis of SDB attending a multidisciplinary spina bifida clinic at a tertiary care pediatric hospital. Clinical and demographic variables are collected at annual clinic visits and entered in the Center for Disease Control and Prevention’s (CDC) National Spina Bifida Patient Registry (NSBPR). Polysomnography (PSG) results were extracted from the hospital’s Sleep Center Database and SDB treatments obtained from chart review. Change in AHI, OI, and diagnosis of SDB was analyzed for patients with at least 2 PSGs. We assessed differences between initial and final PSG results using a McNemar test or Wilcoxon signed rank test.

Results:

Of 55 eligible patients, most were female (53%), and median age was 1.3 years old at initial PSG and 6.6 at final PSG. 78.2% had obstructive sleep apnea (OSA) and 38% had central apnea (CSA). Between the initial and final sleep studies, there was a significant decrease in the median AHI (13.5 vs 4.0; p < .0001) and OI (7.9 vs 1.7; p < .0001), and in the diagnosis of OSA (78% vs 60%; p = .04) and CSA (38% vs 18%; p = .02). Specific SDB treatments or SB-related clinical procedures done between PSGs were not associated with statistically significant changes in AHI or OI (Table 1).

Conclusion(s):

AHI, OI, and diagnosis of SDB (obstructive or central sleep apnea) decreased between initial and final PSGs in patients with SB. Further studies with larger sample size are needed to determine the impact of SDB treatments and SB-related surgical procedures on changes in AHI and OI and identify most effective treatments for SDB in individuals with SB.