Obstructive Sleep Apnea in a Severely Obese Child With Combined Central Sleep Apnea and Sleep-Related Hypoventilation Disorder Caused by a Medullary Tumor

A medullary tumor is a relatively rare disease that causes severe and complicated respiratory disorders, including sleep-related breathing disorders, due to dysregulation of respiratory control. A severely obese 12-year-old male was admitted to our hospital for worsening dyspnea and received a diagnosis of type II respiratory failure. Although obstructive sleep apnea (OSA) and/or obesity hypoventilation syndrome were suspected, a polysomnogram obtained during a nap (nap study) revealed central sleep apnea (CSA) and sleep-related hypoventilation disorder (SRHD) in addition to OSA. Brain magnetic resonance imaging showed a mass in the medulla oblongata. The patient received a diagnosis of CSA/SRHD caused by a medullary tumor, and with OSA. A partial brainstem tumor resection was performed. Noninvasive positive airway pressure therapy was initiated, and was continued after surgery. However, the patient died unexpectedly, 20 months after surgery. When children with sleep problems caused by OSA present with atypical symptoms of OSA, a neurological examination and polysomnography should be conducted to detect CSA and SRHD.