Central sleep apnea in pediatric medulloblastoma: A case report

OBJECTIVE: To report central sleep apnea (CSA) as an underrecognized cause of respiratory morbidity in pediatric posterior fossa tumors and highlight the benefit of CPAP. METHODS: A 3-year-old child with metastatic medulloblastoma involving the fourth ventricle underwent resection, radiotherapy, and chemotherapy. The course was complicated by recurrent respiratory failure, multiple PICU admissions, and unexplained desaturations initially attributed to seizures. Persistent daytime somnolence and episodic apnea prompted polysomnography. RESULTS: Polysomnography showed severe CSA (respiratory event index 68.3/hour; nadir SpO₂ 75%), unifying the prior hypoxic episodes. CPAP (5 cm H₂O) produced rapid improvement, with restored sleep architecture, fewer respiratory events (index 6.3/hour), stable saturation (~97%), and no further prolonged intensive care admissions. The patient completed oncologic therapy and remained stable on domiciliary CPAP. CONCLUSION: CSA should be considered in children with posterior fossa or brainstem-adjacent lesions presenting with unexplained respiratory events; recognition has important implications for multidisciplinary management and long-term outcomes.