A conditional inference tree model for predicting sleep-related breathing disorders in patients with Chiari malformation type 1: Description and external validation

Journal of Clinical Sleep Medicine

Volumn 15, Issue 1, 2019, Pages 89-99

  Ferré, Álex ^a   Poca, María A ^a   De La Calzada, María Dolores ^a   Moncho, Dulce ^a   Urbizu, Aintzane ^b   Romero, Odile ^a,c   Sampol, Gabriel ^a,c,d   Sahuquillo, Juan ^a  

^a HOSPITAL UNIVERSITARI VALL D HEBRON   (Spain)

^b The University of Akron   (United States)

^c INSTITUTO DE SALUD CARLOS III   (Spain)

^d HOSPITAL UNIVERSITARI VALL D HEBRON   (Spain)

Author keywords

Chiari malformation type 1; Craniovertebral junction malformation; Logistic regression; Machine learning; Magnetic resonance imaging; Morphometric analysis; Posterior cranial fossa; Sleep apnea; Sleep disorders; Sleep related breathing disorders

Indexed keywords

ACCURACY; ADOLESCENT; ADULT; AGE; AGED; ARNOLD CHIARI MALFORMATION; ARTICLE; BREATHING DISORDER; CONDITIONAL INFERENCE TREE MODEL; CONFIDENCE INTERVAL; FEMALE; HUMAN; MAJOR CLINICAL STUDY; MALE; MODEL; MULTIVARIATE LOGISTIC REGRESSION ANALYSIS; ODDS RATIO; PROSPECTIVE STUDY; RESPIRATORY DISTURBANCE INDEX; SENSITIVITY AND SPECIFICITY; SEX; SLEEP RELATED BREATHING DISORDER; SUPERVISED MACHINE LEARNING; ALGORITHM; COMPLICATION; MACHINE LEARNING; MIDDLE AGED; POLYSOMNOGRAPHY; PREDICTIVE VALUE; PROCEDURES; REPRODUCIBILITY; SLEEP DISORDERED BREATHING; THEORETICAL MODEL; YOUNG ADULT;

ADOLESCENT; ADULT; AGED; ALGORITHMS; ARNOLD-CHIARI MALFORMATION; FEMALE; HUMANS; MACHINE LEARNING; MALE; MIDDLE AGED; MODELS, THEORETICAL; POLYSOMNOGRAPHY; PREDICTIVE VALUE OF TESTS; PROSPECTIVE STUDIES; REPRODUCIBILITY OF RESULTS; SENSITIVITY AND SPECIFICITY; SLEEP APNEA SYNDROMES; YOUNG ADULT;

EID: 85060208950     PISSN: 15509389     EISSN: 15509397     Source Type: Journal    
DOI: 10.5664/jcsm.7578     Document Type: Article

References (62)

1. Barkovich A, Wippold F, Sherman J, Citrin C. Significance of cerebellar tonsillar position on MR. AJNR Am J Neuroradiol. 1986;7(5):795–799.
2. Marin-Padilla M, Marin-Padilla T. Morphogenesis of experimentally induced Arnold-Chiari malformation. J Neurol Sci. 1981;50(1):29–55.
3. Urbizu A, Poca MA, Vidal X, Rovira A, Sahuquillo J, Macaya A. MRI-based morphometric analysis of posterior cranial fossa in the diagnosis of chiari malformation type I. J Neuroimaging. 2014;24(3):250–256.
4. Sahuquillo J, Poca MA. [Current surgical treatment of Chiari type I malformation and Chiari I-syringomyelia complex]. Neurologia (Barcelona, Spain). 1998;13(5):223–245.
5. Milhorat TH, Chou MW, Trinidad EM, et al. Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery. 1999;44(5):1005–1017.
6. Botelho RV, Bittencourt LRA, Rotta JM, Tufik S. Adult Chiari malformation and sleep apnoea. Neurosurgical Rev. 2005;28(3):169–176.
7. Ali MM, Russell N, Awada A, McLean D. A cranio-cervical malformation presenting as acute respiratory failure. J Emerg Med. 1996;14(5):569–572.
8. Alvarez D, Requena I, Arias M, Valdes L, Pereiro I, De lT. Acute respiratory failure as the first sign of Arnold-Chiari malformation associated with syringomyelia. Eur Respir J. 1995;8(4):661–663.
9. Tsao TC, Juang YC, Chiang YC, Tsai YH, Lan RS, Lee CH. Pneumonia preceding respiratory failure. A rare, easily misleading clinical manifestation in adult Arnold-Chiari malformation. Chest. 1991;99(5):1294–1295.
10. Nogues MA, Gene R, Encabo H. Risk of sudden death during sleep in syringomyelia and syringobulbia. J Neurol Neurosurg Psychiatry. 1992;55(7):585–589.
11. Iwabuchi K, Miyauchi T, Kyuuma Y, Hosaka H, Kunimi Y, Yagishita S. [A sudden-death in a case of Arnold-Chiari malformation (type I) with sleep apnea]. No To Shinkei. 1985;37(6):575–581.
12. Quebada PB, Duhaime AC. Chiari malformation Type I and a dolichoodontoid process responsible for sudden cardiorespiratory arrest. Case report. J Neurosurg. 2005;103(6 Suppl):567–570.
13. Stephany JD, Garavaglia JC, Pearl GS. Sudden death in a 27-year-old man with Chiari I malformation. Am J Forensic Med Pathol. 2008;29(3):249–250.
14. Rocker GM, Macaulay MA, Sangalang V. Sudden death and Chiari malformations. Intensive Care Med. 1995;21(7):621.
15. Martinot A, Hue V, Leclerc F, Vallee L, Closset M, Pruvo JP. Sudden death revealing Chiari type 1 malformation in two children. Intensive Care Med. 1993;19(2):73–74.
16. Adelman S, Dinner DS, Goren H, Little J, Nickerson P. Obstructive sleep apnea in association with posterior fossa neurologic disease. Arch Neurol. 1984;41(5):509–510.
17. Krieger AJ. Respiratory failure as a surgical risk in patients with hindbrain anomalies. Heart Lung. 1973;2(4):546–551.
18. Zolty P, Sanders MH, Pollack IF. Chiari malformation and sleep-disordered breathing: a review of diagnostic and management issues. Sleep. 2000;23(5):637–643.
19. Sahuquillo J, Rubio E, Poca MA, Rovira A, Rodriguez-Baeza A, Cervera C. Posterior fossa reconstruction: a surgical technique for the treatment of Chiari I malformation and Chiari I/syringomyelia complex-preliminary results and magnetic resonance imaging quantitative assessment of hindbrain migration. Neurosurgery. 1994;35(5):874–884; discussion 884–875.
20. Sahuquillo J, Poca MA, Rovira A, Raspall G, Chasampi A. A new surgical technique for the treatment of Chiari I malformation and Chiari I/syringomyelia complex: preliminary results in 10 patients. In: Samii M, ed. Skull Base Surgery: Anatomy, Diagnosis and Treatment. Basel, Switzerland: Karger; 1994:1126–1129.
21. Botelho RV, Bittencourt LR, Rotta JM, Tufik S. The effects of posterior fossa decompressive surgery in adult patients with Chiari malformation and sleep apnea. J Neurosurg. 2010;112(4):800–807.
22. Duran J, Esnaola S, Rubio R, Iztueta A. Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med. 2001;163(3 Pt 1):685–689.
23. Baldwin CM, Griffith KA, Nieto FJ, O’Connor GT, Walsleben JA, Redline S. The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep. 2001;24(1):96–105.
24. Young T, Peppard P, Palta M, et al. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med. 1997;157(15):1746–1752.
25. Marshall NS, Wong KK, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort. J Clin Sleep Med. 2014;10(4):355–362.
26. Gami AS, Olson EJ, Shen WK, et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. J Am College Cardiol. 2013;62(7):610–616.
27. Ferré Á, Poca MA, de la Calzada MD, et al. Sleep-related breathing disorders in Chiari malformation type 1. A prospective study of 90 patients. Sleep. 2017;40(6).
28. Ferré Masó A, Poca MA, de la Calzada MD, Solana E, Romero Tomás O, Sahuquillo J. Sleep disturbance: a forgotten syndrome in patients with Chiari I malformation. Neurologia. 2014;29(5):294–304.
29. Botelho RV, Bittencourt LR, Rotta JM, Tufik S. A prospective controlled study of sleep respiratory events in patients with craniovertebral junction malformation. J Neurosurg. 2003;99(6):1004–1009.
30. Gagnadoux F, Meslier N, Svab I, Menei P, Racineux JL. Sleep-disordered breathing in patients with Chiari malformation: improvement after surgery. Neurology. 2006;66(1):136–138.
31. Henriques-Filho PS, Pratesi R. Sleep apnea and REM sleep behavior disorder in patients with Chiari malformations. Arq Neuropsiquiatr. 2008;66(2b):344–349.
32. Hastie T, Tibshirani R, Friedman JH. The Elements of Statistical Learning: Data Mining, Inference, and Prediction. 2nd ed. New York, NY: Springer; 2001.
33. Hothorn T, Hornik K, Zeileis A. Unbiased recursive partitioning: a conditional inference framework. J Comput Graph Stat. 2006;15(3):651–674.
34. Tanadini LG, Steeves JD, Hothorn T, et al. Identifying homogeneous subgroups in neurological disorders: unbiased recursive partitioning in cervical complete spinal cord injury. Neurorehabil Neural Repair. 2014;28(6):507–515.
35. Seibold H, Zeileis A, Hothorn T. Model-based recursive partitioning for subgroup analyses. Int J Biostat. 2016;12(1):45–63.
36. Zeileis A, Hothorn T, Hornik K. Model-based recursive partitioning. J Comput Graph Stat. 2008;17(2):492–514.
37. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–545.
38. Berry R, Brooks R, Gamaldo C, et al.; for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Version 2.2. Darien, IL: American Academy of Sleep Medicine; 2015.
39. American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999;22(5):667–689.
40. Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg. 2002;127(1):13–21.
41. Moncho D, Poca MA, Minoves T, Ferre A, Canas V, Sahuquillo J. Are evoked potentials clinically useful in the study of patients with Chiari malformation type 1? J Neurosurg. 2017;126(2):606–619.
42. Urbizu A, Martin BA, Moncho D, et al. Machine learning applied to neuroimaging for diagnosis of adult classic Chiari malformation: role of the basion as a key morphometric indicator. J Neurosurg. 2018;129(3):779–791.
43. Hosmer DW, Lemeshow S, Sturdivant RX. Applied Logistic Regression. 3rd ed. Hoboken, New Jersey: Wiley; 2013.
44. Hothorn T, Zeileis A. partykit: a modular toolkit for recursive partytioning in R. J Mach Learn Res. 2015;16:3905–3909.
45. Hudgel DW. Sleep apnea severity classification - revisited. Sleep. 2016;39(5):1165–1166.
46. Ho V, Crainiceanu CM, Punjabi NM, Redline S, Gottlieb DJ. Calibration model for apnea-hypopnea indices: impact of alternative criteria for hypopneas. Sleep. 2015;38(12):1887–1892.
47. Gottlieb DJ, Whitney CW, Bonekat WH, et al. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med. 1999;159(2):502–507.
48. Brown LK. Mild obstructive sleep apnea syndrome should be treated. Pro. J Clin Sleep Med. 2007;3(3):259–262.
49. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–1235.
50. Mueller D, Oro JJ. Prospective analysis of self-perceived quality of life before and after posterior fossa decompression in 112 patients with Chiari malformation with or without syringomyelia. Neurosurg Focus. 2005;18(2):Ecp2.
51. Mestres O, Poca MA, Solana E, et al. [Evaluation of the quality of life of patients with a Chiari type I malformation. A pilot study in a cohort of 67 patients]. Rev Neurol. 2012;55(3):148–156.
52. Littner MR. Mild obstructive sleep apnea syndrome should not be treated. Con. J Clin Sleep Med. 2007;3(3):263–264.
53. Dauvilliers Y, Stal V, Abril B, et al. Chiari malformation and sleep related breathing disorders. J Neurol Neurosurg Psychiatry. 2007;78(12):1344–1348.
54. Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev. 2017;34:70–81.
55. Shiihara T, Shimizu Y, Mitsui T, Saitoh E, Sato S. Isolated sleep apnea due to Chiari type I malformation and syringomyelia. Pediatr Neurol. 1995;13(3):266–267.
56. Keefover R, Sam M, Bodensteiner J, Nicholson A. Hypersomnolence and pure central sleep apnea associated with the Chiari I malformation. J Child Neurol. 1995;10(1):65–67.
57. Marin-Padilla M. Cephalic axial skeletal-neural dysraphic disorders: embryology and pathology. Can J Neurol Sci. 1991;18(2):153–169.
58. Selvadurai S, Al-Saleh S, Amin R, et al. Utility of brain MRI in children with sleep-disordered breathing. Laryngoscope. 2017;127(2):513–519.
59. Amin R, Sayal P, Sayal A, et al. The association between sleep-disordered breathing and magnetic resonance imaging findings in a pediatric cohort with Chiari 1 malformation. Can Respir J. 2015;22(1):31–36.
60. Urbizu A, Ferre A, Poca MA, et al. Cephalometric oropharynx and oral cavity analysis in Chiari malformation Type I: a retrospective case-control study. J Neurosurg. 2017;126(2):626–633.
61. Collop NA, Anderson WM, Boehlecke B, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2007;3(7):737–747.
62. Paul KS, Lye RH, Strang FA, Dutton J. Arnold-Chiari malformation. Review of 71 cases. J Neurosurg. 1983;58(2):183–187.