1332 Brainstem Glioma Unveiled by Sleep Apnea in a Pediatric Patient: A Case Report

Abstract Introduction Sleep disorders can be associated with a variety of neurological disorders including with CNS neoplasms. There have been various cases of CNS neoplasms presenting with sleep disorders including obstructive and central sleep apnea, hypersomnia, narcolepsy, night terrors, epileptic somnambulism, insomnia, and sleep walking. This case report illustrates a case of what sounded like straightforward obstructive sleep apnea at consultation but what turned out to be sleep apnea with a high frequency of central apneas seemingly secondary to a probable brainstem glioma. Report of case(s) A 13 yo male presented with symptoms of snoring, witnessed apneas, nocturnal gasping, daytime tiredness, and nocturia. Past medical history included prediabetes and laryngomalacia (treated with supraglottoplasty in infancy and with subsequent otolaryngology evaluation years later showing no evidence of significant laryngomalacia). Exam was notable for BMI percentile >99% for age, Mallampati 3, 2+ tonsils. Polysomnography (PSG) was ordered for suspected obstructive sleep apnea. The PSG revealed severe sleep apnea (AHI 94.8, OAHI 58.7). All hypopneas were categorized as obstructive by default as central hypopneas were not scored. The apnea events were subtyped with a substantial number of central events present (CAI 36.1, MAI 9.3, OAI 0). Significant desaturations accompanied these respiratory events, with a nadir oxygen saturation of 70%, a mean saturation of 91%, and a cumulative 75 minutes at or below 88%. Given the high frequency of central apneas, an evaluation for causes of central sleep was conducted. An MRI brain revealed an ill-defined FLAIR hyperintense non-enhancing mass adjacent to the posterior medulla oblongata consistent with a glioma. Conclusion The presence of a high frequency of central apneas in a pediatric patient should raise concern for an underlying neurologic disorder. When central apneas are noted in pediatric patients, a thorough evaluation for potential underlying etiologies – including Chiari malformation or intracranial tumors- is essential. Support (if any)