1144 Central Sleep Apnea in a Pediatric Patient With Acute Heart Failure

Abstract

Introduction: Cheyne-Stokes respiration, a disorder found in adult patients with heart failure or strokes, is associated with severity of heart failure and higher mortality rates. Children with heart failure, commonly secondary to congenital heart disease or dilated cardiomyopathy, have increased risk for sleep disordered breathing but rarely have Cheyne stokes breathing. Report of Case: Our patient is a 14-year-old boy with Arts syndrome (sensorineural hearing loss, vision loss due to bilateral optic atrophy, developmental delay, hypotonia, ataxia, proximal muscle weakness and recurrent respiratory infections) presenting to the Emergency Department with one week of viral upper respiratory infection symptoms. The patient was immediately admitted to the cardiac intensive care unit when echocardiogram findings demonstrated a moderately dilated left heart with severely depressed systolic function (Ejection Fraction: 12%). Once his cardiopulmonary status was stable, he began having multiple nocturnal apneic episodes (about 35 seconds per episode) requiring physical stimulus before resuming regular respirations. A baseline polysomnogram (PSG) was ordered for concern for sleep apnea. Additional sleep history from the family was obtained and was negative except for a long-standing history of snoring and witnessed apneas during sleep. Our patient's PSG revealed mild obstructive sleep apnea (AHI 6.27), snoring and severe central sleep apnea (AHI 41.1) alternating with a prolonged respiratory cycle length (59-114 seconds) with a crescendo-decrescendo pattern of flow. According to the AASM adult scoring guidelines, he revealed a classic presentation of central sleep apnea with Cheyne stoke breathing (CSA-CSB) which was more apparent in N1 and N2 phase of sleep and attenuated during REM sleep. Conclusion: CSA-CSB, although more common in the adult population, can also present in children with heart failure. Our case further strengthens the need for future research on the prognostic value of Cheyne's stokes respiration in children with heart failure.