Periodic breathing is indicative of immaturity of respiratory control and is well recognized within the normal limits in both full term and premature infants but unusual beyond infancy and at high altitude. We would like to focus on the importance of recognizing and scoring the pattern of periodic breathing in older children both clinically and in the sleep laboratory as an abnormal breathing pattern that should draw the attention of the treating physician into the possibility of hindbrain malformation or other significant pathology. Despite that sleep disordered breathing including central and obstructive apneas with or without hypoventilation are well reported as a manifestation of Chiari type I malformation, scoring periodic breathing pattern beyond infancy has not been an area of focus.

3-year-old healthy female child with new onset of sleep disordered breathing consistent with extensive pattern of periodic breathing diagnosed by polysomnogram study. As periodic breathing is indicative of immaturity of respiratory control and the possibility of hindbrain malformation or other significant pathology, subsequent MRI was obtained and showed Chiari Type 1 Malformation. Scoring of periodic breathing pattern beyond infancy in the sleep centers using the American Academy of sleep medicine scoring manual guidelines is of great importance and may warrant further evaluation with MRI for neurological etiologies including Chiari Type 1 malformation.