This study presents two cases of central sleep apnea syndrome in children, highlighting the utility of assessing ventilatory control stability, particularly loop gain and central chemosensitivity in treatment decision-making. In the first case, elevated loop gain for oxygen correlated with periodic breathing, leading to successful treatment with supplemental oxygen in a 13 year-old boy with Prader-Willi-like syndrome. Conversely, in the second case, dealing with a 10 year-old girl with tumor in the brainstem-spinal cord junction, reduced loop gain prompted treatment with nocturnal non-invasive ventilation. These findings underscore the potential clinical relevance of loop gain measurement in pediatric central sleep apnea. While further research is needed to validate these findings in larger cohorts, loop gain endotyping shows promise as a tool for personalized treatment selection in pediatric sleep-disordered breathing.
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