Being diagnosed with basilar invagination can be quite unsettling, to say the least. According to research, 88% of patients with basilar invagination experienced sleep apnea in a study. Therefore, it is crucial for you to have a sleep study done as soon as possible after a diagnosis of basilar invagination. Here's why a sleep study is important and what treatments are available for both basilar invagination and sleep apnea.

What is the connection between basilar invagination and sleep apnea? 

Basilar invagination occurs when the base of the skull folds inward when the top of the second cervical vertebra moves upward. This causes a narrowing of the opening of the skull for the spinal cord, which is called the foramen magnum. In some cases, basilar invagination can press on the lower portion of the brain stem. The compression of the cranial nerves and the brain stem is believed to cause serious sleep problems, particularly with sleep apnea. 

What type of sleep study should be done? 

A sleep study done for the purpose of determining whether or not someone with basilar invagination has sleep apnea should be done in a sleep clinic instead of a home sleep study. The reason for this is due to the possibly detrimental issues that go along with brain stem compression and the ability to have a registered polysomnographic technologist readily watching the results of your sleep study in real time. 

What are the treatments for these conditions, particularly when they are comorbid? 

If the study shows that you do have sleep apnea and that it is severe, the best way to treat it is to treat your basilar invagination with an endoscopic endonasal approach. This type of approach allows the surgeon to use your nasal passageways to reach the area of the basilar invagination to surgically remove the inward folds at the base of the skull. After surgery, a follow-up sleep study to ensure there are no lingering sleep apnea issues is recommended. 

However, the treatment for basilar invagination is different if your sleep apnea is not severe. You may need to wear a cervical collar to prevent the cervical vertebra from affecting the cranial nerves and putting pressure on your brain stem. Additionally, non-steroidal anti-inflammatory medication may be prescribed as well as physical therapy. During treatment for non-severe sleep apnea and basilar invagination, it is crucial for you to continue to have sleep studies done on a regular basis, which can be determined by your neurosurgeon based on your medical case.