case_images: PMC10809326_01
case_images: PMC10809326_02
case_images: Physical features of this girl showed the child's wide and flat skull deformity, large eye slits, wide interocular distance, protruding eyeballs, bilateral exotropia, absence of upper eyelid ptosis, small and low nasal bridge (A). The forehead is high and prominent, the posterior part of the skull is flat, and the skull has a cloverleaf appearance, with a central arched elevation and bilateral depressions (B). The ears are low-set, with bilateral closed external ear canals (C). The big toe is wide and malformed (D).
case_images: fneur-14-1337236-g001.jpg
case_images: PMC10809326_02_fneur-14-1337236-g001.jpg
case_images: fig1
case_images: Upon evaluation at sleep clinic, the patient's physical examination revealed craniofacial and limb deformities (Figure 1).
case_images: Illustration of PSG report showed that in the first half of the monitoring, the girl did not enter deep sleep, experienced frequent episodes of obstructive hypopnea, and had frequent drops in oxygen saturation accompanied by significant heart rate variability. In the second half of the monitoring with an oropharyngeal airway, the girl could enter deep sleep, significantly reducing obstructive hypopnea. However, central sleep apnea events were observed.
case_images: fneur-14-1337236-g002.jpg
case_images: PMC10809326_02_fneur-14-1337236-g002.jpg
case_images: fig2
case_images: The girl underwent a split PSG recording (Figure 2).
case_images: Obstructive hypopnea and central sleep apnea in the diagnostic PSG. (A) In the first half of the night, the routine PSG monitoring showed that the girl experienced frequent obstructive hypopnea with paradoxical breathing. (B) In the second half of the night, severe central sleep apnea events were observed after she wore an oropharyngeal airway.
case_images: fneur-14-1337236-g003.jpg
case_images: PMC10809326_02_fneur-14-1337236-g003.jpg
case_images: fig3
case_images: From 23:25 to 03:26 am, the regular PSG revealed a severe AHI of 117.7 events/h, consisting solely of obstructive hypopnea (Table 1; Figure 3A). However, the central sleep apnea index was 11.9 events per hour (Table 1; Figure 3B), resulting in an overall AHI of 15.6 events per hour.