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Lloyd RM, Crawford T, Donald R, Gray DD, Healy WJ, Junna MR, Lewin D, Revana A, Schutte-Rodin S. Quality measures for the care of pediatric patients with obstructive sleep apnea: 2023 update after measure maintenance. J Clin Sleep Med 2024; 20:127-134. [PMID: 37772707 PMCID: PMC10758557 DOI: 10.5664/jcsm.10836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023]
Abstract
Obstructive sleep apnea (OSA) is the most common respiratory sleep disorder in the United States in preschool and school-aged children. In an effort to continue addressing gaps and variations in care in this patient population, the American Academy of Sleep Medicine (AASM) Quality Measures Task Force performed quality measure maintenance on the Quality Measures for the Care of Pediatric Patients with Obstructive Sleep Apnea (originally developed in 2015). The Quality Measures Task Force reviewed the current medical literature, including updated clinical practice guidelines and systematic literature reviews, existing pediatric OSA quality measures, and performance data highlighting remaining gaps or variations in care since implementation of the original quality measure set to inform any potential revisions to the quality measures. These revised quality measures have been implemented in the AASM Sleep Clinical Data Registry (Sleep CDR) to capture performance data and encourage continuous quality improvement, specifically in outcomes associated with diagnosing and managing OSA in the pediatric population. CITATION Lloyd RM, Crawford T, Donald R, et al. Quality measures for the care of pediatric patients with obstructive sleep apnea: 2023 update after measure maintenance. J Clin Sleep Med. 2024;20(1):127-134.
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Affiliation(s)
| | | | | | | | - William J. Healy
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | | | - Daniel Lewin
- Sleep Health and Wellness Center, Santa Barbara, California
| | - Amee Revana
- Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Sharon Schutte-Rodin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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2
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Cole MC, Raphael JL, Katkin JP, Yenduri NJS, Gazzaneo MC, Revana A, Anagnostou A, Farber HJ. Asthma outcomes in pediatric patients with 30-day follow-up after an asthma hospitalization in a Medicaid-managed care program. J Asthma 2023:1-7. [PMID: 36893220 DOI: 10.1080/02770903.2023.2185155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND National asthma guidelines recommend an outpatient follow-up after hospitalization for asthma. Our aim is determine if a follow-up visit within 30 days after an asthma hospitalization impacts risk for re-hospitalization and emergency department visits for asthma within the following year. METHODS This was a retrospective cohort study of claims data of Texas Children's Health Plan (a Medicaid managed care program) members age 1 to <18 years and hospitalized for asthma between January 1, 2012, and December 31, 2018. Primary outcomes were days to re-hospitalization and emergency department visit between 30 days and 365 days following the index hospitalization. RESULTS We identified 1,485 children age 1 to <18 years hospitalized for asthma. Comparing those with a 30 day follow-up to those without, there was no difference in days to re-hospitalization (adjusted hazard ratio 1.23, 95% Confidence Interval (CI) 0.74-2.06) or emergency department visit for asthma (aHR 1.08, 95% CI 0.88-1.33). Inhaled corticosteroid and short acting beta agonist dispensing were greater in the group completing the 30 day follow-up (means of 2.8 and 4.8 respectively for those with follow-up, 1.6 and 3.5 respectively for those without, p < 0.0001). CONCLUSION Having a follow-up outpatient visit within 30 days of an asthma hospitalization is not associated with a decrease in asthma re-hospitalization or emergency department visit in the 30-365 day period following the index hospitalization. Non-adherence to regular use of inhaled corticosteroid medication was high in both groups. These findings suggest need for improvement in the quality and quantity of post hospital asthma follow-up.
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Affiliation(s)
- Melissa C Cole
- Pediatrics, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jean L Raphael
- Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Julie P Katkin
- Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Naga Jaya Smitha Yenduri
- Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Maria C Gazzaneo
- Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Amee Revana
- Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Aikaterini Anagnostou
- Pediatrics, Division of Allergy and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Harold J Farber
- Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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Lloyd R, Morgenthaler TI, Donald R, Gray DD, Lewin D, Revana A, Schutte-Rodin S, Trotti LM. Quality measures for the care of adult patients with obstructive sleep apnea: 2022 update after measure maintenance. J Clin Sleep Med 2022; 18:2673-2680. [PMID: 36308029 PMCID: PMC9622990 DOI: 10.5664/jcsm.10244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022]
Abstract
Obstructive sleep apnea (OSA) remains a highly prevalent disorder that can lead to multiple adverse outcomes when undiagnosed and/or when left untreated. There continue to be gaps and variations in the provision of care for the adult patient population with OSA, which emphasizes the importance of the measure maintenance initiative for The Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea (originally developed in 2015). The American Academy of Sleep Medicine (AASM) convened the Quality Measures Task Force in 2018 to review the current medical literature, other existing quality measures focused on the same patient population, and any performance data or data in the medical literature that show gaps or variations in care, to inform potential revisions to the quality measure set. These revised quality measures will be implemented in the AASM Sleep Clinical Data Registry (Sleep CDR) to capture performance data and encourage continuous improvement in outcomes associated with diagnosing and managing OSA in the adult population. CITATION Lloyd R, Morgenthaler TI, Donald R, et al. Quality measures for the care of adult patients with obstructive sleep apnea: 2022 update after measure maintenance. J Clin Sleep Med. 2022;18(11):2673-2680.
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Affiliation(s)
| | | | | | | | - Daniel Lewin
- Children’s National Medical Center, Washington, DC
| | - Amee Revana
- Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Sharon Schutte-Rodin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lynn Marie Trotti
- Emory Sleep Center and Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
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Duis J, Pullen LC, Picone M, Friedman N, Hawkins S, Sannar E, Pfalzer AC, Shelton AR, Singh D, Zee PC, Glaze DG, Revana A. Diagnosis and management of sleep disorders in Prader-Willi syndrome. J Clin Sleep Med 2022; 18:1687-1696. [PMID: 35172921 PMCID: PMC9163612 DOI: 10.5664/jcsm.9938] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Clinical experience and a growing body of evidence suggest that sleep disturbances are common in people with Prader-Willi syndrome (PWS). PWS is a rare neuroendocrine disorder characterized by early hypotonia and feeding difficulties; developmental delays; endocrinopathies; and behavioral concerns, especially rigidity, anxiety, and behavioral outbursts. PWS is also characterized by decreased resting energy expenditure and transition to hyperphagia and obesity. We propose that, for many people with PWS, clinical diagnosis and management of sleep disorders is an unmet need. We present current information to suggest disordered sleep is a significant burden for individuals with PWS and often overlooked. While central and obstructive sleep apnea are more widely recognized in PWS, other sleep disorders have increasingly gained recognition, including hypersomnia, narcolepsy-like phenotypes, and insomnia. Sleep disorders can impact behavior, cognition, and quality of life and health for individuals with PWS. Our goal is to bring sleep disorders to the forefront of therapeutic intervention for patients with PWS. This paper presents a review of the literature and recommendations for clinical practice based on published research and our clinical experience as sleep specialists, geneticists, psychiatrists, pediatricians, otolaryngologists, and pulmonologists with extensive experience with this patient population. We recommend that management of sleep be considered an integral part of successful medical management of PWS. Further research concerning sleep problems in PWS is urgently needed to develop best practices and work toward a consensus statement for medical management to meet the needs of people with PWS. CITATION Duis J, Pullen LC, Picone M, et al. Diagnosis and management of sleep disorders in Prader-Willi syndrome. J Clin Sleep Med. 2022;18(6):1687-1696.
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Affiliation(s)
- Jessica Duis
- Section of Genetics and Inherited Metabolic Diseases, Section of Pediatrics Special Care Clinic, Prader-Willi Syndrome Multidisciplinary Clinic, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Address correspondence to: Jessica Duis, MD, MS, Assistant Professor of Pediatrics and Genetics, Section of Genetics and Inherited Metabolic Diseases, Section of Pediatrics Special Care Clinic, Director, Prader-Willi Syndrome Multidisciplinary Clinic, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO 80045; Tel: (303) 724-2370;
| | | | | | - Norman Friedman
- Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephen Hawkins
- Breathing Institute, Children’s Hospital Colorado, Aurora, Colorado
| | - Elise Sannar
- Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Deepan Singh
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, New York
| | - Phyllis C. Zee
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel G. Glaze
- The Children’s Sleep Center, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Amee Revana
- Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
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Willis A, Petitto L, Revana A. 0812 Periodic Limb Movements in the Setting of Pediatric Traumatic Brain Injury. Sleep 2022. [DOI: 10.1093/sleep/zsac079.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Sleep disturbances following traumatic brain injury (TBI) are commonly diagnosed and can affect up to 70% of individuals, with many occurring after mild injuries such as concussions.1 Patients can experience a variety of sleep problems such as sleep-wake disturbances, infrequent parasomnias, and periodic limb movement disorders. While periodic limb movements (PLMs) can occur in pediatric patients, they are rare compared to their adult counterparts. Literature is limited regarding the presence of PLMs post-concussion in the pediatric population. We describe an unusual case of PLMs in the setting of mild TBI in a pediatric patient.
Report of Cases: A 6-year-old male with a past medical history significant for adeno-tonsillar hypertrophy and chronic cough was brought to the emergency department by ambulance after being found facedown secondary to a fall at school. Physical examination findings were significant for dried blood at the nares with an abrasion to the anterior nasal bridge. No other signs of trauma were noted, and his Glasgow Coma Scale (GCS) was 15. Computerized Tomography (CT) scan of the head was negative for any acute intracranial abnormality. He was diagnosed with a mild TBI and sent home with concussion precautions. Prior to his concussion, at the age of 4, he was diagnosed with obstructive sleep apnea (OSA) via polysomnography (PSG). Moderate OSA was noted with an apnea hypopnea index (AHI) of 8.1 per hour leading to adenotonsillectomy. Five weeks after his concussion, an evaluation by the pediatrician revealed complaints of restless sleep and worsened emotional lability prompting a referral to the sleep clinic. By comparison, the patient’s post-TBI PSG at age 6 showed no evidence of sleep-disordered breathing (AHI of 1.48 per hour) but with new periodic limb movements and an elevated PLM index of 6.56 per hour. An iron panel is pending.
Conclusion
PLMs in the setting of pediatric TBI is a rarely diagnosed entity and, to our knowledge, has never been reported in the literature. Our case suggests that clinicians should have a high level of suspicion for sleep problems post-TBI and consider PSG to assess for PLMs which can affect recovery and the overall quality-of-life of the pediatric patient.
Support (If Any)
Viola-Saltzman M, Watson NF. Traumatic brain injury and sleep disorders. Neurol Clin. 2012;30(4):1299-1312. doi:10.1016/j.ncl.2012.08.008
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Affiliation(s)
- Aaron Willis
- Texas Children's Hospital/ Baylor College of Medicine
| | - Lacie Petitto
- Texas Children's Hospital/ Baylor College of Medicine
| | - Amee Revana
- Texas Children's Hospital/ Baylor College of Medicine
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Dang L, Kaplan K, Revana A. 0838 Cheyne-Stokes Breathing in a Pediatric Patient with Dilated Cardiomyopathy and Muscular Dystrophy Prior to Heart Transplant. Sleep 2022. [DOI: 10.1093/sleep/zsac079.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Cheyne-Stokes breathing (CSB) has rarely been identified in the pediatric population. Neuromuscular diseases (NMD) such as Duchene Muscular Dystrophy (DMD) can predispose patients to sleep-disordered breathing including central sleep apnea (CSA) and CSB. Sleep-disordered breathing in children with NMD may not have symptoms; thus, treatment can be delayed. Currently, there is limited data to support resolution of CSB in DMD with dilated cardiomyopathy post-transplant.
Report of Cases: We present a 15-year old female with a significant history of both dilated cardiomyopathy and DMD who presented with acute on chronic heart failure. Due to her disease progression, she was listed for heart transplant. Prior to her transplant, she completed an inpatient polysomnography (PSG) to rule out sleep-disordered breathing due to concerns of snoring and dyspnea during sleep. Her Pediatric Daytime Sleepiness Scale score (PDSS) was 8. The polysomnogram recorded moderate obstructive sleep apnea (OSA) and central sleep apnea
(CSA) consistent with Cheyne-Stokes breathing along with rare premature ventricular
contractions (PVCs). Patient was started on BPAP of 13/8 cm H2O with a back-up rate of 12
breaths per minute after titration study. The patient subsequently received a heart transplant in
which the patient’s dyspnea and snoring resolved. Post-transplant PSG pending to reassess the
severity of sleep-disordered breathing.
Conclusion
Though CSA can be seen in children, CSB is rarely seen in children with either heart failure or muscular dystrophy. When CSB is observed, the cornerstone of treatment is correcting the underlying cause. This patient demonstrated CSB with symptoms that improved with BPAP and now post-heart transplant. When both heart failure and neuromuscular disease are involved, close monitoring for clinical symptoms along with screening for CSB is important and may affect overall quality of life and recovery.
Support (If Any)
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Affiliation(s)
| | - Kevin Kaplan
- Baylor College of Medicine, Texas Chidlren's Hospital
| | - Amee Revana
- Baylor College of Medicine, Texas Children’s Hospital
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Patel VP, Patroneva A, Glaze DG, Davis MS K, Merikle E, Revana A. Establishing the content validity of the Epworth Sleepiness Scale for Children and Adolescents in Prader-Willi syndrome. J Clin Sleep Med 2022; 18:485-496. [PMID: 34437052 PMCID: PMC8804999 DOI: 10.5664/jcsm.9632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Excessive daytime sleepiness is common in Prader-Willi syndrome (PWS), with prevalence ranging from 52% to 100%. The goal of this study was to establish the content validity (ie, evidence that an instrument measures an intended concept of interest) of the parent/caregiver version of the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), a measure of daytime sleepiness, in PWS. METHODS Qualitative, dyadic semistructured video interviews were conducted with 18 caregivers and their children with PWS from April to June 2020. Concept elicitation and cognitive interview techniques were implemented. Thematic analyses allowed for examination of themes and data patterns. RESULTS All caregivers (mean age 49 years) were mothers of individuals with PWS who experienced troublesome daytime sleepiness (mean age 14 years). The most prevalent observable signs/symptoms of daytime sleepiness were sleepy/sleepiness (n = 17; 94.4%), tired/tiredness (n = 16; 88.9%), exhaustion/exhausted (n = 5; 27.8%), anxious/stressed (n = 5; 27.8%), irritable/frustrated (n = 5; 27.8%), having tantrums/outbursts (n = 5; 27.8%), and lethargy (n = 4; 22.2%). Daytime sleepiness impacted various aspects of health including mental, emotional, physical, and social well-being. When caregivers were asked about the activities associated with daytime sleepiness, all salient concepts elicited mapped to the ESS-CHAD; saturation was met after the first 4 interviews. Only 2 concepts, after physical exertion and while inactive/bored, did not map. Caregiver statements indicated that these concepts, although related to daytime activities, were atypical of daily routines. The ESS-CHAD was well understood and relevant to caregivers. CONCLUSIONS This study supports the content validity of the ESS-CHAD and its appropriateness for evaluating treatment efficacy of daytime sleepiness in PWS. CITATION Patel VP, Patroneva A, Glaze DG, Davis K, Merikle E, Revana A. Establishing the content validity of the Epworth Sleepiness Scale for Children and Adolescents in Prader-Willi syndrome. J Clin Sleep Med. 2022;18(2):485-496.
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Revana A, Vecchio J, Guffey D, Minard CG, Glaze DG. Clinical application of home sleep apnea testing in children: a prospective pilot study. J Clin Sleep Med 2022; 18:533-540. [PMID: 34534072 PMCID: PMC8805000 DOI: 10.5664/jcsm.9650] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES (1) To determine the sensitivity and specificity of the home sleep apnea test (HSAT) performed in typically developing children who were diagnosed with moderate to severe obstructive sleep apnea during overnight attended laboratory polysomnography (LPSG). (2) To determine the utility of a screening questionnaire to identify children at increased risk for obstructive sleep apnea. METHODS Participants completed 2 consecutive study nights, the first night with the HSAT followed by LPSG on the second night. The SHOOTS questionnaire, composed of 6 questions (snoring, hyperactivity, obesity, observed apnea, tonsillar hypertrophy, and sleepiness) concerning sleep-disordered breathing, was administered by the clinician before the first study night. RESULTS Thirty-eight participants completed both studies. The mean age was 13.8 ± 3.0 years. Twenty (53%) were male. Most participants were obese. The mean LPSG total sleep time was 7.34 ± 1.19 hours; the mean HSAT total recording time was 8.86 ± 1.73 hours (P < .001). The median obstructive apnea-hypopnea index for LPSG and HSAT was 6.6 and 0.8 events/h, respectively. For an obstructive apnea-hypopnea index ≥ 3.1 events/h by HSAT, the sensitivity was 71.43% (95% confidence interval, 41.9-91.6) and the specificity was 95.83% (95% confidence interval, 78.9-99.9) for identifying those with an LPSG obstructive apnea-hypopnea index of ≥ 10 events/h. For a SHOOTS score with ≥ 4 "yes" responses, the sensitivity and specificity were 85.7% (95% confidence interval, 57.2-98.2) and 54.2% (95% confidence interval, 32.8-74.4), respectively, for identifying those with an LPSG obstructive apnea-hypopnea index ≥ 10 events/h. CONCLUSIONS Using HSAT, we clinically applied cutoff values to identify moderate to severe obstructive sleep apnea in typically developing children. The SHOOTS questionnaire may aid in identifying children at risk for obstructive sleep apnea and who are candidates for HSAT. CITATION Revana A, Vecchio J, Guffey D, Minard CG, Glaze DG. Clinical application of home sleep apnea testing in children: a prospective pilot study. J Clin Sleep Med. 2022;18(2):533-540.
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Affiliation(s)
- Amee Revana
- Address correspondence to: Amee Revana, DO, Texas Children’s Hospital, 6621 Fannin Street, Houston, TX 77030; or Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030;
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Willis A, Petitto L, Revana A. 852 Severe Central Sleep Apnea in a Patient with Cornelia de Lange Syndrome. Sleep 2021. [DOI: 10.1093/sleep/zsab072.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Cornelia de Lange syndrome (CdLS) is a rare multisystem disorder with characteristic facial dysmorphisms, upper airway structural abnormalities, and varying degrees of intellectual and neurologic deficits. Affected patients can have many sleep problems including chronic insomnia and obstructive sleep apnea; however, there is no literature indicating central sleep apnea as a common sleep disorder in this patient population. We describe a patient with CdLS with an unusual presentation of both severe obstructive and central sleep apnea.
Report of case(s)
The patient is a 12-year-old female with CdLS, global developmental delay, repaired bilateral cleft-palate, and oropharyngeal dysphagia. She was referred for diagnostic polysomnography for evaluation of snoring. Physical examination findings were significant for distinctive features of the head and face including microcephaly, micrognathia, and synophrys. Neurologically, the patient was non-verbal and wheelchair bound. Pre-evaluation screening indicated no concerns from the caregiver regarding problems with sleep initiation, maintenance, or daytime symptoms. Polysomnography (PSG) at age 7 years revealed severe obstructive and central sleep apnea with an apnea-hypopnea index (AHI) of 78.2/hr. The majority of these were central events (68.44/hr). There were no epileptiform foci recorded. Bilevel Positive Airway Pressure (BPAP) in Spontaneous/Timed (S/T) mode was titrated during the study which resolved all central events. Magnetic resonance imaging of the brain was obtained indicating mild hypoplasia of the corpus callosum. Since the initial PSG, 5 additional routine studies were conducted and progressive worsening of central sleep apnea was noted with the highest recorded AHI of 108.8/hr (central events: 81.4/hr). Apneic events were fairly managed with BPAP in ST mode.
Conclusion
Sleep-disordered breathing in CdLS is an increasingly diagnosed entity. While previous literature indicates airway obstruction as a common cause for sleep apnea in children with CdLS, our case suggests that clinicians should consider central causes of sleep apnea in these patients. Given the sub-clinical progression of sleep apnea in this case study, routine follow up PSGs should be considered. Further research is necessary to increase knowledge of the incidence and management of central sleep apnea in children with CdLS.
Support (if any):
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Affiliation(s)
- Aaron Willis
- Texas Children’s Hospital / Baylor College of Medicine
| | | | - Amee Revana
- Texas Children’s Hospital / Baylor College of Medicine
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Emanuel H, Revana A, Te T, Kaplan K. 830 Combined Phototherapy and Melatonin for treatment of Circadian Rhythm Disorder in a Patient with Cornelia de Lange Syndrome. Sleep 2021. [DOI: 10.1093/sleep/zsab072.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Cornelia de Lange syndrome (CdLS) is a rare genetic disorder characterized by variable physical, cognitive, and behavioral characteristics. Sleep disturbances have been frequently reported in CdLS including insomnia, sleep-disordered breathing, intrinsic sleep disorders, and circadian rhythm disorders (CRDs). The characterization and prevalence of CRDs in CdLS remain ill- defined. We report a case of a 13-year-old female with CdLS presenting with advanced sleep wake phase disorder (ASWPD).
Report of case(s)
A 13-year-old female with a past medical history of CdLS, developmental delay, bilateral cleft palate status post repair presents with inability to fall asleep at night and excessive daytime sleepiness.(EDS) Her sleep history consists of going to bed at 4 pm with no delayed sleep onset. She wakes at 2:30 am which has occurred since infancy. Mother reports the patient will remain awake from 2:30 am until she goes to school at 7:30 am. History is consistent with EDS and sleeping during the day while at school. Total sleep time of approximately 11–12 hours was reported in 24-hour period. History of obstructive sleep apnea, parasomnias, insomnia, restless leg syndrome, and psychotropic medications were not reported. Patient was treated with timed low dose melatonin therapy 0.5 mg at 4 pm and bright light therapy using 10,000 lux for 30 minutes at 7 am and 4 pm. Dim lights starting at 7:30 pm with structured scheduled sleep hygiene ensuring consistent bedtime at 9:30 pm. A consistent wake time at 7 am and no naps during the day was recommended. Follow up visits report successful response to therapy with attainment of desired sleep wake rhythm (bedtime at 9:30 pm and wake time at 7 am) and resolution of sleepiness during the day. Our patient was able to be weaned off of melatonin and light therapy and her circadian rhythm remained entrained.
Conclusion
Patients with disorder such as CdLS are at risk for circadian rhythm disorders. Our patient responded well to treatment with combined timed phototherapy and low dose melatonin therapy. Better knowledge and characterization of typology of CRDs in CdLS patients could permit a more specific therapeutic approach to sleep disorders in this population.
Support (if any)
None
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Affiliation(s)
| | - Amee Revana
- Texas Children’s Hospital / Baylor College of Medicine
| | - Tue Te
- Baylor College of Medicine
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