Sleep in Children with Myelomeningocele

Children with myelomeningocele may experience a myriad of health challenges. In this chapter, we review the general medical and surgical care of these children, neurosurgical considerations, the pathophysiology underlying potential associated sleep-related breathing disorders, management approaches for sleep apnea, and other breathing disorders, challenges, and special considerations for noninvasive support, and sleep disorders beyond sleep apnea. Given the potential complex nature of medical issues in these children, we advocate for a multidisciplinary approach to their care. Abnormal brainstem function, chemoreceptor responsiveness, parenchymal pulmonary disease, and upper airway anatomy/function may all contribute to sleep-related breathing disorders including a combination of obstructive sleep apnea, central sleep apnea, hypoxemia, and/or hypoventilation. As such, management must be individualized to a given patient’s particular pathophysiology and overall goals of care, and a stepwise approach may include one or several of the following: supplemental oxygen, noninvasive positive airway pressure, or surgery (otolaryngology and neurosurgery evaluations). If these measures are ineffective, then tracheostomy with mechanical ventilation may be the appropriate next step. Likewise, episodes of acute respiratory failure or severe apnea may require placement of a tracheostomy. We discuss advanced modes of noninvasive ventilatory support and how lessons learned from other neuromuscular populations may apply to children with myelomeningocele. Finally, the limited available evidence also suggests that these children are at risk for other sleep disorders beyond those of respiration, including the effects of altered chronotype on sleep initiation and daytime sleepiness.