Sleep-disordered breathing and its management in children with rare skeletal dysplasias

Am J Med Genet A. 2021 Jul;185(7):2108-2118. doi: 10.1002/ajmg.a.62236. Epub 2021 Apr 28.

Abstract

Sleep-disordered breathing (SDB) is common in patients with skeletal dysplasias. The aim of our study was to analyze SDB and respiratory management in children with rare skeletal dysplasias. We performed a retrospective analysis of patients with spondyloepiphyseal dysplasia congenita (SEDC), metatropic dysplasia (MD), spondyloepimetaphyseal dysplasia (SEMD), acrodysostosis (ADO), geleophysic dysplasia (GD), acromicric dysplasia (AD), and spondylocostal dysplasia (SCD) between April 2014 and October 2020. Polygraphic data, clinical management, and patients' outcome were analyzed. Thirty-one patients were included (8 SEDC, 3 MD, 4 SEMD, 1 ADO, 4 GD, 3 AD, and 8 SCD). Sixteen patients had obstructive sleep apnea (OSA): 11 patients (2 with SEDC, 1 with SEMD, 1 with ADO, 1 with GD, 2 with AD, and 4 with SCD) had mild OSA, 2 (1 SEMD and 1 GD) had moderate OSA, and 3 (1 SEDC, 1 MD, 1 SEMD) had severe OSA. Adenotonsillectomy was performed in one patient with SCD and mild OSA, and at a later age in two other patients with ADO and AD. The two patients with moderate OSA were treated with noninvasive ventilation (NIV) because of nocturnal hypoxemia. The three patients with severe OSA were treated with adenotonsillectomy (1 SEDC), adeno-turbinectomy and continuous positive airway pressure (CPAP; 1 MD), and with NIV (1 SEMD) because of nocturnal hypoventilation. OSA and/or alveolar hypoventilation is common in patients with skeletal dysplasias, underlining the importance of systematic screening for SDB. CPAP and NIV are effective treatments for OSA and nocturnal hypoventilation/hypoxemia.

Keywords: alveolar hypoventilation; obstructive sleep apnea; polygraphy; skeletal dysplasia; sleep; sleep-disordered breathing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoidectomy
  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Continuous Positive Airway Pressure / methods
  • Dysostoses / congenital*
  • Dysostoses / diagnostic imaging
  • Dysostoses / pathology
  • Dysostoses / therapy
  • Female
  • Humans
  • Infant
  • Intellectual Disability / diagnostic imaging
  • Intellectual Disability / pathology
  • Intellectual Disability / therapy*
  • Male
  • Osteochondrodysplasias / congenital*
  • Osteochondrodysplasias / diagnostic imaging
  • Osteochondrodysplasias / pathology
  • Osteochondrodysplasias / therapy
  • Polysomnography
  • Ribs / abnormalities*
  • Ribs / diagnostic imaging
  • Ribs / pathology
  • Sleep Apnea Syndromes / diagnostic imaging
  • Sleep Apnea Syndromes / pathology
  • Sleep Apnea Syndromes / therapy*
  • Sleep Apnea, Obstructive / diagnostic imaging
  • Sleep Apnea, Obstructive / pathology
  • Sleep Apnea, Obstructive / therapy*
  • Spine / abnormalities*
  • Spine / diagnostic imaging
  • Spine / pathology
  • Tonsillectomy
  • Treatment Outcome
  • Young Adult

Supplementary concepts

  • Acrodysostosis
  • Spondylocostal Dysostosis 4, Autosomal Dominant
  • Spondyloepiphyseal dysplasia, congenita