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Basa M, Pesovic J, Savic-Pavicevic D, Peric S, Meola G, Amaddeo A, Kovacevic G, Ostojic S, Sovtic A. Evaluation of Sleep-Disordered Breathing and Respiratory Dysfunction in Children with Myotonic Dystrophy Type 1-A Retrospective Cross-Sectional Study. Biomedicines 2025; 13:966. [PMID: 40299556 PMCID: PMC12024916 DOI: 10.3390/biomedicines13040966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Revised: 03/26/2025] [Accepted: 04/10/2025] [Indexed: 05/01/2025] Open
Abstract
Background/Objectives: Myotonic dystrophy type 1 (DM1) is a rare neuromuscular disorder characterized by respiratory dysfunction that significantly impacts quality of life and longevity. This study aimed to explore the outcomes of pulmonary function tests and sleep-disordered breathing (SDB) workups in children with DM1 and to identify the factors contributing to SDB. Methods: A retrospective study examined patients' medical records, including genetic analyses, clinical characteristics, and noninvasive pulmonary function testing (PFT), when possible. The Pediatric Sleep Questionnaire (PSQ), arterial blood gases, polygraphy, and overnight transcutaneous capnometry (PtcCO2) were used to assess SDB. Results: The size of CTG expansion in the DMPK gene directly correlated with the severity of respiratory complications and the need for early tracheostomy tube insertion in 7/20 (35%) patients. A total of 13/20 (65%) children were available for respiratory evaluation during spontaneous breathing. While moderate/severe obstructive sleep apnea syndrome (OSAS) and hypoventilation were confirmed in 4/13 (31%) children, none of the patients had mixed or dominantly central sleep apnea syndrome. There was no correlation between apnea-hypopnea index (AHI) or PtcCO2 and the presence of SDB-related symptoms or the PSQ score. Although a significant correlation between AHI and PtcCO2 was not confirmed (p = 0.447), the oxygen desaturation index directly correlated with PtcCO2 (p = 0.014). Conclusions: While SDB symptoms in children with DM1 may not fully correlate with observed respiratory events or impaired gas exchange during sleep, a comprehensive screening for SDB should be considered for all patients with DM1. Further research into disease-specific recommendations encompassing the standardization of PFT, as well as overnight polygraphic and capnometry recordings, could help to guide timely, personalized treatment.
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Affiliation(s)
- Mihail Basa
- Department of Pulmology, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, 11070 Belgrade, Serbia;
| | - Jovan Pesovic
- Center for Human Molecular Genetics, Faculty of Biology, University of Belgrade, 11158 Belgrade, Serbia; (J.P.); (D.S.-P.)
| | - Dusanka Savic-Pavicevic
- Center for Human Molecular Genetics, Faculty of Biology, University of Belgrade, 11158 Belgrade, Serbia; (J.P.); (D.S.-P.)
| | - Stojan Peric
- Faculty of Medicine, University of Belgrade, 11158 Belgrade, Serbia; (S.P.); (G.K.); (S.O.)
- Neurology Clinic, University Clinical Center of Serbia, 11158 Belgrade, Serbia
| | - Giovanni Meola
- Department of Neurorehabilitation Sciences, Casa Di Cura Igea, 20129 Milan, Italy;
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
- Fondazione Malattie Miotoniche ETS—FMM ETS, 20144 Milan, Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Gordana Kovacevic
- Faculty of Medicine, University of Belgrade, 11158 Belgrade, Serbia; (S.P.); (G.K.); (S.O.)
- Neurology Department, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, 11070 Belgrade, Serbia
| | - Slavica Ostojic
- Faculty of Medicine, University of Belgrade, 11158 Belgrade, Serbia; (S.P.); (G.K.); (S.O.)
- Neurology Department, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, 11070 Belgrade, Serbia
| | - Aleksandar Sovtic
- Department of Pulmology, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, 11070 Belgrade, Serbia;
- Faculty of Medicine, University of Belgrade, 11158 Belgrade, Serbia; (S.P.); (G.K.); (S.O.)
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Neukamm AC, Quante M, Poets CF, Shellhaas RA. The impact of sleep in high-risk infants. Pediatr Res 2025:10.1038/s41390-025-04049-2. [PMID: 40210954 DOI: 10.1038/s41390-025-04049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Revised: 01/31/2025] [Accepted: 02/24/2025] [Indexed: 04/12/2025]
Abstract
Most of an infant's day is devoted to sleep - and normal sleep is vital to normal brain development. Sleep disruptions may impair overall health, well-being, and neurodevelopment. Disruptors of sleep and circadian health, such as noise, light, respiratory support, and clinical interventions, are highly prevalent in hospital and nursing care facilities. These factors particularly affect infants who already have an increased risk of sleep disorders and their consequences due to an underlying disease. Preterm infants and infants with disorders such as neonatal abstinence syndrome, craniofacial malformations, congenital heart disease, hypoxic-ischemic encephalopathy, Chiari-malformation/myelomeningocele, congenital musculoskeletal disease, and Down syndrome are all at high risk for impaired development of sleep-wake cycling and for sleep-disordered breathing. Since abnormal sleep is a potentially treatable risk factor for impaired neurodevelopment, there is an urgent need for effective monitoring, timely interventions, and treatment strategies to improve sleep physiology and thereby optimize overall neurodevelopment in these high-risk populations. IMPACT: Healthy sleep plays a fundamental role in normal infant brain development. Many factors can disrupt sleep during a hospital stay. This is particularly important for infants who have an increased risk of sleep disorders due to neonatal disorders such as prematurity, congenital heart disease, or Chiari malformation. Sleep protective strategies are readily available and need to be systematically implemented into hospital care.
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Affiliation(s)
| | - Mirja Quante
- Department of Neonatology, University of Tuebingen, Tuebingen, Germany.
| | - Christian F Poets
- Department of Neonatology, University of Tuebingen, Tuebingen, Germany
| | - Renée A Shellhaas
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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D'Ambrosio ES, Rose M, Chagat S, Paul GR, Waldrop MA. Comparison of Two Questionnaires for Sleep-Related Symptoms in Pediatric and Adult Patients With Myotonic Dystrophy Type 1. Muscle Nerve 2025; 71:606-610. [PMID: 39921245 DOI: 10.1002/mus.28371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 01/29/2025] [Accepted: 02/01/2025] [Indexed: 02/10/2025]
Abstract
INTRODUCTION/AIMS Sleep-related symptoms in myotonic dystrophy type 1 (DM1) are often unrecognized. This study aimed to integrate two sleep questionnaires into an outpatient clinic for assessing sleep disturbances in DM1 patients, while also developing a pediatric version of one questionnaire. METHODS We administered two sleep questionnaires to adult and pediatric patients with DM1: (1) the Epworth Sleepiness Scale (ESS), which assesses the likelihood of falling asleep under specific circumstances; and (2) the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), which evaluates the impact of daytime sleepiness on activities of daily living. We also developed a pediatric version of the adult FOSQ-10 and compared it to the pediatric ESS. RESULTS Among 28 DM1 patients, 27 completed the questionnaires. More than half (15 of 26, eight children and seven adults) had abnormal scores on either or both questionnaires. FOSQ-10 scores tended to be more abnormal than ESS scores in pediatric patients. No significant correlations were found between questionnaire scores and CTG repeats, intellectual disability, age, or inheritance pattern. The pediatric FOSQ-10 questionnaire showed a strong correlation with the pediatric ESS correlation coefficient -0.79 (p = 0.002). DISCUSSION The integration of the ESS and the FOSQ-10 allowed for a more comprehensive assessment of fatigue, a well-documented symptom in DM1 and one that the ESS alone might not fully capture. Our findings highlight the importance of incorporating multiple tools to assess sleep-related symptoms in DM1 patients.
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Affiliation(s)
- Eleonora Silvana D'Ambrosio
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Megan Rose
- The Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Shannon Chagat
- Department of Pediatrics and Neurology, Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Grace R Paul
- Division of Pulmonary and Sleep Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Megan A Waldrop
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics and Neurology, Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
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Trucco F, Lizio A, Roma E, di Bari A, Salmin F, Albamonte E, Casiraghi J, Pozzi S, Becchiati S, Antonaci L, Salvalaggio A, Catteruccia M, Tosi M, Marinella G, Danti FR, Bruschi F, Veneruso M, Parravicini S, Fiorillo C, Berardinelli A, Pini A, Moroni I, Astrea G, Battini R, D’Amico A, Ricci F, Pane M, Mercuri EM, Johnson NE, Sansone VA. Association between Reported Sleep Disorders and Behavioral Issues in Children with Myotonic Dystrophy Type 1-Results from a Retrospective Analysis in Italy. J Clin Med 2024; 13:5459. [PMID: 39336946 PMCID: PMC11432637 DOI: 10.3390/jcm13185459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Sleep disorders have been poorly described in congenital (CDM) and childhood (ChDM) myotonic dystrophy despite being highly burdensome. The aims of this study were to explore sleep disorders in a cohort of Italian CDM and ChDM and to assess their association with motor and respiratory function and disease-specific cognitive and behavioral assessments. Methods: This was an observational multicenter study. Reported sleep quality was assessed using the Pediatric Daytime Sleepiness Scale (PDSS) and Pediatric Sleep Questionnaire (PSQ). Sleep quality was correlated to motor function (6 min walk test, 6MWT and grip strength; pulmonary function (predicted Forced Vital Capacity%, FVC% pred.); executive function assessed by BRIEF-2; autism traits assessed by Autism Spectrum Screening Questionnaire (ASSQ) and Repetitive Behavior Scale-revised (RBS-R); Quality of life (PedsQL) and disease burden (Congenital Childhood Myotonic Dystrophy Health Index, CCMDHI). Results: Forty-six patients were included, 33 CDM and 13 ChDM, at a median age of 10.4 and 15.1 years. Daytime sleepiness and disrupted sleep were reported by 30% children, in both subgroups of CDM and ChDM. Daytime sleepiness correlated with autism traits in CDM (p < 0.05). Disrupted sleep correlated with poorer executive function (p = 0.04) and higher disease burden (p = 0.03). Conclusions: Sleep issues are a feature of both CDM and ChDM. They correlate with behavioral issues and impact on disease burden.
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Affiliation(s)
- Federica Trucco
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
- Department of Neurorehabilitation, University of Milan, 20122 Milan, Italy
- Paediatric Neurology and Muscular Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genoa, Italy
| | - Andrea Lizio
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Elisabetta Roma
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Alessandra di Bari
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Francesca Salmin
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Emilio Albamonte
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Jacopo Casiraghi
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Susanna Pozzi
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Stefano Becchiati
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Laura Antonaci
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Università Cattolica del Sacro Cuore, 00136 Roma, Italy; (L.A.); (M.P.); (E.M.M.)
| | - Anna Salvalaggio
- Department of Sciences of Public Health and Pediatrics, University of Turin, 10124 Turin, Italy; (A.S.); (F.R.)
| | - Michela Catteruccia
- UOS Malattie Muscolari e Neurodegenerative—Ospedale Pediatrico Bambino Gesù, 00165 Roma, Italy; (M.C.); (M.T.); (A.D.)
| | - Michele Tosi
- UOS Malattie Muscolari e Neurodegenerative—Ospedale Pediatrico Bambino Gesù, 00165 Roma, Italy; (M.C.); (M.T.); (A.D.)
| | - Gemma Marinella
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone Pisa, Italy; (G.M.); (G.A.); (R.B.)
| | - Federica R. Danti
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.D.); (I.M.)
| | - Fabio Bruschi
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.D.); (I.M.)
| | - Marco Veneruso
- Unit of Child Neuropsychiatry, IRCCS Istituto Giannina Gaslini and DINOGMI, University of Genova, 16132 Genova, Italy; (M.V.); (C.F.)
| | - Stefano Parravicini
- Child and Adolescent Neuromuscular Disorders Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (S.P.); (A.B.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Chiara Fiorillo
- Unit of Child Neuropsychiatry, IRCCS Istituto Giannina Gaslini and DINOGMI, University of Genova, 16132 Genova, Italy; (M.V.); (C.F.)
| | - Angela Berardinelli
- Child and Adolescent Neuromuscular Disorders Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (S.P.); (A.B.)
| | - Antonella Pini
- Pediatric Neuromuscular Unit, UOC Neuropsichiatria dell’età Pediatrica, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy;
| | - Isabella Moroni
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.D.); (I.M.)
| | - Guja Astrea
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone Pisa, Italy; (G.M.); (G.A.); (R.B.)
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone Pisa, Italy; (G.M.); (G.A.); (R.B.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Adele D’Amico
- UOS Malattie Muscolari e Neurodegenerative—Ospedale Pediatrico Bambino Gesù, 00165 Roma, Italy; (M.C.); (M.T.); (A.D.)
| | - Federica Ricci
- Department of Sciences of Public Health and Pediatrics, University of Turin, 10124 Turin, Italy; (A.S.); (F.R.)
| | - Marika Pane
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Università Cattolica del Sacro Cuore, 00136 Roma, Italy; (L.A.); (M.P.); (E.M.M.)
| | - Eugenio M. Mercuri
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Università Cattolica del Sacro Cuore, 00136 Roma, Italy; (L.A.); (M.P.); (E.M.M.)
| | - Nicholas E. Johnson
- Department of Neurology, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Valeria A. Sansone
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
- Department of Neurorehabilitation, University of Milan, 20122 Milan, Italy
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Cascais I, Garrido C, Morais L, Amorim R, Lima R, Mansilha HF, Correia T, Oliveira A, Santos M. Myotonic dystrophy type 1 (Steinert disease): 29 years of experience at a tertiary pediatric hospital. Eur J Paediatr Neurol 2024; 48:85-90. [PMID: 38088012 DOI: 10.1016/j.ejpn.2023.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/19/2023] [Accepted: 12/03/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is a multisystemic disorder caused by the expansion of a noncoding triplet repeat. METHODS A cross-sectional study was performed to characterize pediatric patients with DM1 followed in a tertiary hospital over the last 29 years, comparing the congenital and the childhood/juvenile-onset forms. RESULTS Thirty-seven patients (59.5 % male) were included, with a median age at the latest assessment of 16.8 years and a median follow-up of 7.7 years. Eleven patients were lost to follow-up, and two died. Twenty-five had congenital DM1 (CDM1), and this form had significantly higher triplet repeat length, history of polyhydramnios, lower median age at diagnosis, and first and last assessment. Common symptoms included distal skeletal muscle weakness (75.7 %) and facial involvement (94.6 %), along with dysphonia/dysarthria (73.0 %) and myotonia (73.0 %). Delayed independent ambulation frequency was significantly higher for CDM1 cases. Skeletal deformities affected 54.1 %, with talipes equinovarus and scoliosis occurring exclusively in CDM1 patients. Cognitive deficit was present in 75.7 % of cases. Polysomnograms revealed seven cases of obstructive sleep apnea and two of hypoventilation. Noninvasive ventilation was used in nine cases, and three had recurrent respiratory infections. The cardiovascular system was affected in 21.6 % of cases. Gastrointestinal issues included constipation (24.3 %), feeding difficulties (16.2 %), and cholelithiasis (5.4 %). Cataracts, epilepsy, and diabetes mellitus were reported in two cases each. CONCLUSION Our study highlights the diverse spectrum of severity and multiorgan involvement of DM1 in pediatric patients. It underscores the importance of establishing a pediatric-specific standard of care to enhance health outcomes through comprehensive multidisciplinary management.
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Affiliation(s)
- Inês Cascais
- Department of Pediatrics, Centro Materno Infantil Do Norte (CMIN), Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
| | - Cristina Garrido
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - Lurdes Morais
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - Rosa Amorim
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - Rosa Lima
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - Helena Ferreira Mansilha
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - Teresa Correia
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - António Oliveira
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - Manuela Santos
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
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Pascoe JE, Zygmunt A, Ehsan Z, Gurbani N. Sleep in pediatric neuromuscular disorders. Semin Pediatr Neurol 2023; 48:101092. [PMID: 38065635 DOI: 10.1016/j.spen.2023.101092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 12/18/2023]
Abstract
Sleep disordered breathing (SDB) is prevalent among children with neuromuscular disorders (NMD). The combination of respiratory muscle weakness, altered drive, and chest wall distortion due to scoliosis make sleep a stressful state in this population. Symptomatology can range from absent to snoring, nocturnal awakenings, morning headaches, and excessive daytime sleepiness. Sequelae of untreated SDB includes cardiovascular effects, metabolic derangements, and neurocognitive concerns which can be compounded by those innate to the NMD. The clinician should have a low threshold for obtaining polysomnography and recognize the nuances of individual disorders due to disproportionately impacted muscle groups such as hypoventilation in ambulating patients from diaphragm weakness. Non-invasive or invasive ventilation are the mainstay of treatment. In this review we explore the diagnosis and treatment of SDB in children with various NMD.
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Affiliation(s)
- John E Pascoe
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
| | - Alexander Zygmunt
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Neepa Gurbani
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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