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Francisco GR, Simões JLB, de Carvalho Braga G, Guerra PH, Bagatini MD. The outcomes of growth hormone therapy in the obstructive sleep apnea parameters of Prader-Willi syndrome patients: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:2235-2242. [PMID: 38133808 DOI: 10.1007/s00405-023-08406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Prader-Willi syndrome is a serious genetic condition, capable of causing endocrinological imbalance, which has as one of its main treatments the growth hormone therapy. However, this therapy still causes some uncertainty concerning its effects on the respiratory parameters of those patients, especially in cases of obstructive sleep apnea, therefore, presenting a need for the analysis of the relationship between the therapy and the otolaryngologic condition. METHODS A systematic review following the PRISMA model was developed, with searches for keywords made in the databases PubMed (MEDLINE), Scopus, and Web of Science and registration in the PROSPERO platform (CRD42023404250). RESULTS Three randomized controlled trials were considered eligible for inclusion in the review. None of the studies demonstrated statistically significant modifications in the obstructive sleep apnea parameters of Prader-Willi patients related to the growth hormone administration. CONCLUSIONS Growth hormone therapy is safe for Prader-Willi syndrome patients when analyzing their obstructive sleep apnea parameters.
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Pham TT, Davis SM, Tong S, Campa KA, Friedman NR, Gitomer SA. High Prevalence of Obstructive Sleep-Disordered Breathing in Pediatric Patients With Turner Syndrome. Otolaryngol Head Neck Surg 2024; 170:905-912. [PMID: 37937707 DOI: 10.1002/ohn.576] [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: 01/07/2023] [Revised: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE Girls with Turner syndrome (TS) often have features that have been associated with obstructive sleep-disordered breathing (oSDB). However, little is known about oSDB in TS. Herein, we aimed to characterize oSDB in young patients with TS and identify associated risk factors. STUDY DESIGN Retrospective cross-sectional study. SETTING Tertiary care pediatric hospital. METHODS We reviewed medical records for patients diagnosed with TS seen at our institution between October 1, 2007 and December 31, 2019 with the first outpatient visit before age 6 years. The prevalence of oSDB was compared to the general pediatric population with 1-sample binomial proportion tests. Clinical characteristics were compared between those diagnosed with oSDB and those without oSDB, and risk factors for oSDB were identified. RESULTS Of 151 patients with TS, 73 (48%) were diagnosed with oSDB which is 4-fold higher than the general pediatric population (12%, P < 0.0001). In the multivariable model, adenoid, tonsillar, and inferior turbinate hypertrophy, birthweight, failure to thrive, and older age at the last clinic visit were all associated with increased odds for oSDB. CONCLUSION Young children with TS have a high prevalence of oSDB and thus should be screened for oSDB. Polysomnography should be performed in those with associated risk factors and symptoms oSDB. Treatment of oSDB is imperative as individuals with TS are already at increased risk of behavioral problems, neurocognitive deficits, and growth impairment that may be worsened with oSDB.
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Affiliation(s)
- Tiffany T Pham
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shanlee M Davis
- Department of Pediatrics, Section of Endocrinology, Children's Hospital of Colorado, Aurora, Colorado, USA
- eXtraOrdinary Kids Turner Syndrome Clinic, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Suhong Tong
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Khaled A Campa
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Norman R Friedman
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatric Otolaryngology, Children's Hospital of Colorado, Aurora, Colorado, USA
- Children's Sleep Medicine Laboratory, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Sarah A Gitomer
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- eXtraOrdinary Kids Turner Syndrome Clinic, Children's Hospital of Colorado, Aurora, Colorado, USA
- Department of Pediatric Otolaryngology, Children's Hospital of Colorado, Aurora, Colorado, USA
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Guo H, Fu J, Zhou Y, Luo F, Cheng R. Evaluating the effect of recombinant human growth hormone treatment on sleep-related breathing disorders in toddlers with Prader-Willi syndrome: a one-year retrospective cohort study. BMC Pediatr 2024; 24:32. [PMID: 38200464 PMCID: PMC10777505 DOI: 10.1186/s12887-023-04513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Recombinant human growth hormone (rhGH) therapy is beneficial for children with Prader-Willi syndrome (PWS) in improving short stature and metabolism, but the effect of early rhGH treatment on respiratory and sleep parameters for PWS children under three years old remains elusive. Thus, this study aimed to investigate the impact of rhGH treatment on sleep-related breathing disorders (SRBDs) for toddlers with PWS. METHODS A total of 17 age-matched PWS patients receiving rhGH treatment (rhGH group) and 17 control individuals not receiving rhGH treatment (non-rhGH group) were recruited for this study between October 2018 and January 2023. Data related to polysomnography-polygraphy (PSG) and serum levels of insulin-like growth factor (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) were collected. RESULTS The mean age in the rhGH group was 20.76 ± 9.22 months, which was comparable to that of the non-rhGH group (25.23 ± 13.81 months). The demographic and anthropometric parameters were similar across the two groups after 52 weeks of treatment. Administration of rhGH to toddlers did not exert adverse effects on the obstructive apnea-hypopnea index (OAHI), central apnea index (CAI), oxygen desaturation index (ODI), mean percutaneous oxygen saturation (SpO2), lowest SpO2, duration when SpO2 is lower than 90%, or proportion of the patients with SpO2 lower than 90%. Furthermore, the increased IGF-1 z-score and IGFBP-3 level did not worsen SRBDs. CONCLUSION Treatment with rhGH for 52 weeks on young toddlers with PWS showed no deleterious effects on SRBDs. This shed more light on the importance of initiating rhGH therapy early in PWS patients.
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Affiliation(s)
- Haiyan Guo
- Institute of Pediatrics, Children's Hospital of Fudan University, National Children's Medical Center, and the Shanghai Key Laboratory of Medical Epigenetics, International Co-Laboratory of Medical Epigenetics and Metabolism, Ministry of Science and Technology, Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, 201102, China
| | - Jinrong Fu
- Department of General Medicine, National Children's Medical Center,Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Yufeng Zhou
- Institute of Pediatrics, Children's Hospital of Fudan University, National Children's Medical Center, and the Shanghai Key Laboratory of Medical Epigenetics, International Co-Laboratory of Medical Epigenetics and Metabolism, Ministry of Science and Technology, Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, 201102, China
| | - Feihong Luo
- Department of Endocrinology and Inherited Metabolic Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Ruoqian Cheng
- Department of Endocrinology and Inherited Metabolic Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, China.
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Zaffanello M, Pietrobelli A, Piacentini G, Guzzo A, Antoniazzi F. The Impact of Growth Hormone Therapy on Sleep-Related Health Outcomes in Children with Prader-Willi Syndrome: A Review and Clinical Analysis. J Clin Med 2023; 12:5504. [PMID: 37685570 PMCID: PMC10488332 DOI: 10.3390/jcm12175504] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
This literature review of growth hormone (GH) therapy and sleep-related health outcomes in children diagnosed with Prader-Willi syndrome (PWS) assembles evidence for the consequences of sleep deprivation and poor sleep quality: difficulty concentrating and learning at school, behavioral problems, diminished quality of life, and growth impairment. Sleep-disordered breathing (SDB) is another factor that impacts a child's well-being. We searched the electronic databases Medline PubMed Advanced Search Builder, Scopus, and Web of Science using MeSH terms and text words to retrieve articles on GH deficiency, recombinant human growth hormone (rhGH) therapy, sleep quality, SDB, and PWS in children. The censor date was April 2023. The initial search yielded 351 articles, 23 of which were analyzed for this review. The study findings suggest that while GH may have a role in regulating sleep, the relationship between GH treatment and sleep in patients with PWS is complex and influenced by GH dosage, patient age, and type and severity of respiratory disorders, among other factors. GH therapy can improve lung function, linear growth, and body composition in children with PWS; however, it can also trigger or worsen obstructive sleep apnea or hypoventilation in some. Long-term GH therapy may contribute to adenotonsillar hypertrophy and exacerbate sleep apnea in children with PWS. Finally, GH therapy can improve sleep quality in some patients but it can also cause or worsen SDB in others, leading to diminished sleep quality and overall quality of life. The current evidence suggests that the initial risk of worsening SDB may improve with long-term therapy. In conclusion, rhGH is the standard for managing patients with PWS. Nonetheless, its impact on respiratory function during sleep needs to be thoroughly evaluated. Polysomnography is advisable to assess the need for adenotonsillectomy before initiating rhGH therapy. Close monitoring of sleep disorders in patients with PWS receiving GH therapy is essential to ensure effective and safe treatment.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy; (A.P.); (G.P.); (F.A.)
| | - Angelo Pietrobelli
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy; (A.P.); (G.P.); (F.A.)
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy; (A.P.); (G.P.); (F.A.)
| | - Alessandra Guzzo
- Department of Pathology and Diagnostics, School of Medicine, University of Verona, 37129 Verona, Italy;
| | - Franco Antoniazzi
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy; (A.P.); (G.P.); (F.A.)
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Abstract
PURPOSE OF REVIEW This paper reviews how sleep is impacted in patients with Prader-Willi syndrome (PWS), focusing on sleep-related breathing disturbances and excessive daytime sleepiness (EDS). RECENT FINDINGS Hypothalamic dysfunction may underlie several aspects of the PWS phenotype. Central sleep apnea (CSA) can persist beyond infancy. Nocturnal hypoventilation is common and may occur without central or obstructive sleep apnea (OSA). Adenotonsillectomy, a mainstay of OSA treatment, may cause velopharyngeal insufficiency. Growth hormone (GH) is considered safe, but close surveillance for OSA remains important. Cardiac autonomic dysfunction occurs during slow wave sleep and may increase the risk of cardiovascular events. EDS and narcolepsy are also common. Modafinil and pitolisant are treatment options currently being studied. Sleep disorders are prevalent in individuals with PWS. Sleep-related breathing disorders present as CSA in infancy and later in life as OSA and hypoventilation. GH therapy has improved the clinical outcomes of patients with PWS, but close surveillance and treatment for OSA is recommended. EDS can persist even after sleep-related breathing disorders are treated, and some individuals may even develop narcolepsy. Early recognition and treatment of sleep-related disorders may prevent morbidity and result in improved survival of patients with PWS.
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Mattia D, Lindblade C, Oatman O, Prakash S, Grebe T. Novel Case of Prader–Willi Syndrome and Ebstein's Anomaly: Implications for Complex Care Management. J Pediatr Genet 2022. [DOI: 10.1055/s-0042-1757449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractWe present a patient with a complex phenotype including diagnoses of Ebstein's anomaly and Prader–Willi syndrome (PWS) as well as additional congenital anomalies and genetic variants with potential clinical effects. This is the first reported case of both diagnoses present in the same patient. The diagnosis of Ebstein's anomaly was made on prenatal ultrasound. She presented with neonatal hypotonia, feeding problems, and dysmorphic features, followed by later onset weight gain, leading to a diagnosis of PWS. Further evaluations revealed Blaschkoid hyperpigmentation, laryngeal cleft, and pigmentary retinopathy. Whole exome sequencing determined a likely pathogenic variant in alkaline phosphatase gene and several mitochondrial DNA variants. We discuss the known genetic mechanisms of PWS and compare them to the heterogenous genetic associations of Ebstein's anomaly. The standard of care treatment for PWS is growth hormone therapy, which is associated with right-sided heart failure risks. This case illustrates the need to complete the diagnostic work up in all patients, as well as the necessity of a multidisciplinary approach for optimal outcomes.
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Affiliation(s)
- Donald Mattia
- Department of General Pediatrics, Phoenix Children's Hospital, Phoenix, Arizona, United States
| | - Christopher Lindblade
- Department of Cardiology, Phoenix Children's Hospital, Phoenix, Arizona, United States
| | - Oliver Oatman
- Department of Endocrinology, Phoenix Children's Hospital, Phoenix, Arizona, United States
| | - Supraja Prakash
- Department of Genetics and Metabolism, Phoenix Children's Hospital, Phoenix, Arizona, United States
| | - Theresa Grebe
- Department of Genetics and Metabolism, Phoenix Children's Hospital, Phoenix, Arizona, United States
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7
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Preserved Sleep for the Same Level of Respiratory Disturbance in Children with Prader-Willi Syndrome. Int J Mol Sci 2022; 23:ijms231810580. [PMID: 36142494 PMCID: PMC9501212 DOI: 10.3390/ijms231810580] [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: 08/08/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022] Open
Abstract
Debate remains as to how to balance the use of recombinant human growth hormone (rhGH) as an important treatment in Prader-Willi syndrome (PWS) with its potential role in obstructive sleep apnea. This single-center, retrospective study assessed differences in overnight polysomnography results between children with and without PWS and changes in respiratory parameters before and after the initiation of rhGH treatment in those with PWS. Compared with age-, sex-, and body-mass-index-matched controls (n = 87), children with PWS (n = 29) had longer total sleep time (434 ± 72 vs. 365 ± 116 min; p < 0.01), higher sleep efficiency (86 ± 7 vs. 78 ± 15%; p < 0.05), and lower arousal events (8.1 ± 4.5 vs. 13.0 ± 8.9 events/h; p < 0.05). Mean oxygen saturation was lower in PWS children (94.3 ± 6.0 vs. 96.0 ± 2.0%; p < 0.05), with no other differences in respiratory parameters between groups. Eleven children with PWS (38%) met the criteria for further analyses of the impact of rhGH; polysomnography parameters did not change with treatment. Compared with other children undergoing polysomnography, children with PWS had more favorable markers of sleep continuity and lower oxygen saturation for the same level of respiratory disturbance. rhGH administration was not associated with changes in respiratory parameters in PWS.
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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] [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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Dodet P, Sanapo F, Leu-Semenescu S, Coupaye M, Bellicha A, Arnulf I, Poitou C, Redolfi S. Sleep Disorders in Adults with Prader–Willi Syndrome: Review of the Literature and Clinical Recommendations Based on the Experience of the French Reference Centre. J Clin Med 2022; 11:jcm11071986. [PMID: 35407596 PMCID: PMC8999159 DOI: 10.3390/jcm11071986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Prader–Willi syndrome (PWS) is a rare, genetic, multisymptomatic, neurodevelopmental disease commonly associated with sleep alterations, including sleep-disordered breathing and central disorders of hypersomnolence. Excessive daytime sleepiness represents the main manifestation that should be addressed by eliciting the detrimental effects on quality of life and neurocognitive function from the patients’ caregivers. Patients with PWS have impaired ventilatory control and altered pulmonary mechanics caused by hypotonia, respiratory muscle weakness, scoliosis and obesity. Consequently, respiratory abnormalities are frequent and, in most cases, severe, particularly during sleep. Adults with PWS frequently suffer from sleep apnoea syndrome, sleep hypoxemia and sleep hypoventilation. When excessive daytime sleepiness persists after adequate control of sleep-disordered breathing, a sleep study on ventilatory treatment, followed by an objective measurement of excessive daytime sleepiness, is recommended. These tests frequently identify central disorders of hypersomnolence, including narcolepsy, central hypersomnia or a borderline hypersomnolent phenotype. The use of wake-enhancing drugs (modafinil, pitolisant) is discussed in multidisciplinary expert centres for these kinds of cases to ensure the right balance between the benefits on quality of life and the risk of psychological and cardiovascular side effects.
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Affiliation(s)
- Pauline Dodet
- Centre de Référence des Narcolepsies et Hypersomnies Rares, Service des Pathologies du Sommeil (Département R3S), Hôpital la Pitié-Salpêtrière, APHP-Sorbonne, 75013 Paris, France; (F.S.); (S.L.-S.); (I.A.); (S.R.)
- Institut du Cerveau (ICM), INSERM, CNRS, Hôpital la Pitié-Salpêtrière, Sorbonne University, 75013 Paris, France
- Correspondence:
| | - Federica Sanapo
- Centre de Référence des Narcolepsies et Hypersomnies Rares, Service des Pathologies du Sommeil (Département R3S), Hôpital la Pitié-Salpêtrière, APHP-Sorbonne, 75013 Paris, France; (F.S.); (S.L.-S.); (I.A.); (S.R.)
| | - Smaranda Leu-Semenescu
- Centre de Référence des Narcolepsies et Hypersomnies Rares, Service des Pathologies du Sommeil (Département R3S), Hôpital la Pitié-Salpêtrière, APHP-Sorbonne, 75013 Paris, France; (F.S.); (S.L.-S.); (I.A.); (S.R.)
- Institut du Cerveau (ICM), INSERM, CNRS, Hôpital la Pitié-Salpêtrière, Sorbonne University, 75013 Paris, France
| | - Muriel Coupaye
- Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Department of Nutrition, Hôpital la Pitié-Salpêtrière, APHP-Sorbonne, 75013 Paris, France; (M.C.); (C.P.)
| | - Alice Bellicha
- INSERM U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), Sorbonne Paris Nord University, 93017 Bobigny, France;
| | - Isabelle Arnulf
- Centre de Référence des Narcolepsies et Hypersomnies Rares, Service des Pathologies du Sommeil (Département R3S), Hôpital la Pitié-Salpêtrière, APHP-Sorbonne, 75013 Paris, France; (F.S.); (S.L.-S.); (I.A.); (S.R.)
- Institut du Cerveau (ICM), INSERM, CNRS, Hôpital la Pitié-Salpêtrière, Sorbonne University, 75013 Paris, France
| | - Christine Poitou
- Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Department of Nutrition, Hôpital la Pitié-Salpêtrière, APHP-Sorbonne, 75013 Paris, France; (M.C.); (C.P.)
- Nutrition and Obesities: Systemic Approaches (NutriOmics), INSERM, Sorbonne University, 75013 Paris, France
| | - Stefania Redolfi
- Centre de Référence des Narcolepsies et Hypersomnies Rares, Service des Pathologies du Sommeil (Département R3S), Hôpital la Pitié-Salpêtrière, APHP-Sorbonne, 75013 Paris, France; (F.S.); (S.L.-S.); (I.A.); (S.R.)
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne University, 75005 Paris, France
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, 09134 Cagliari, Italy
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Bamba V, Kanakatti Shankar R. Approach to the Patient: Safety of Growth Hormone Replacement in Children and Adolescents. J Clin Endocrinol Metab 2022; 107:847-861. [PMID: 34636896 DOI: 10.1210/clinem/dgab746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Indexed: 02/07/2023]
Abstract
The use of recombinant human growth hormone (rhGH) in children and adolescents has expanded since its initial approval to treat patients with severe GH deficiency (GHD) in 1985. rhGH is now approved to treat several conditions associated with poor growth and short stature. Recent studies have raised concerns that treatment during childhood may affect morbidity and mortality in adulthood, with specific controversies over cancer risk and cerebrovascular events. We will review 3 common referrals to a pediatric endocrinology clinic, followed by a summary of short- and long-term effects of rhGH beyond height outcomes. Methods to mitigate risk will be reviewed. Finally, this information will be applied to each clinical case, highlighting differences in counseling and clinical outcomes. rhGH therapy has been used for more than 3 decades. Data are largely reassuring, yet we still have much to learn about pharmaceutical approaches to growth in children and the lifelong effect of treatment.
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Affiliation(s)
- Vaneeta Bamba
- The Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Roopa Kanakatti Shankar
- The George Washington University School of Medicine, Children's National Hospital, Washington, DC 20010, USA
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11
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Caudri D, Nixon GM, Nielsen A, Mai L, Hafekost CR, Kapur N, Seton C, Tai A, Blecher G, Ambler G, Bergman PB, Vora KA, Crock P, Verge CF, Tham E, Musthaffa Y, Lafferty AR, Jacoby P, Wilson AC, Downs J, Choong CS. Sleep-disordered breathing in Australian children with Prader-Willi syndrome following initiation of growth hormone therapy. J Paediatr Child Health 2022; 58:248-255. [PMID: 34397126 PMCID: PMC9290886 DOI: 10.1111/jpc.15691] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 04/08/2021] [Accepted: 07/15/2021] [Indexed: 12/20/2022]
Abstract
AIM In children with Prader-Willi syndrome (PWS), growth hormone (GH) improves height and body composition; however, may be associated with worsening sleep-disordered breathing (SDB). Some studies have reported less SDB after GH initiation, but follow-up with polysomnography is still advised in most clinical guidelines. METHODS This retrospective, multicentre study, included children with PWS treated with GH at seven PWS treatment centres in Australia over the last 18 years. A paired analysis comparing polysomnographic measures of central and obstructive SDB in the same child, before and after GH initiation was performed with Wilcoxon signed-rank test. The proportion of children who developed moderate/severe obstructive sleep apnoea (OSA) was calculated with their binomial confidence intervals. RESULTS We included 112 patients with available paired data. The median age at start of GH was 1.9 years (range 0.1-13.5 years). Median obstructive apnoea hypopnoea index (AHI) at baseline was 0.43/h (range 0-32.9); 35% had an obstructive AHI above 1.0/h. Follow-up polysomnography within 2 years after the start of GH was available in 94 children who did not receive OSA treatment. After GH initiation, there was no change in central AHI. The median obstructive AHI did not increase significantly (P = 0.13), but 12 children (13%, CI95% 7-21%) developed moderate/severe OSA, with clinical management implications. CONCLUSIONS Our findings of a worsening of OSA severity in 13% of children with PWS support current advice to perform polysomnography after GH initiation. Early identification of worsening OSA may prevent severe sequelae in a subgroup of children.
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Affiliation(s)
- Daan Caudri
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western AustraliaPerthWestern AustraliaAustralia,Department of Paediatric PulmonologyErasmus MC – Sophia Children's HospitalRotterdamThe Netherlands
| | - Gillian M Nixon
- Melbourne Children's Sleep CentreMonash Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
| | - Aleisha Nielsen
- Respiratory and Sleep Medicine, Perth Children's HospitalPerthWestern AustraliaAustralia
| | - Linda Mai
- Faculty of Medicine and Health SciencesThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Claire R Hafekost
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western AustraliaPerthWestern AustraliaAustralia
| | - Nitin Kapur
- Respiratory and Sleep Medicine, Queensland Children's HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, University of QueenslandBrisbaneQueenslandAustralia
| | - Chris Seton
- Department of Sleep MedicineChildren's Hospital WestmeadSydneyNew South WalesAustralia,Woolcock Institute of Medical Research, Sydney UniversitySydneyNew South WalesAustralia
| | - Andrew Tai
- Respiratory and Sleep DepartmentWomen's and Children's HospitalAdelaideSouth AustraliaAustralia,Robinson Research Institute, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Greg Blecher
- Department of Sleep MedicineSydney Children's HospitalRandwickNew South WalesAustralia
| | - Geoff Ambler
- The Sydney Children's Hospitals NetworkWestmeadNew South WalesAustralia,Discipline of Child and Adolescent Health, The University of SydneySydneyNew South WalesAustralia
| | - Philip B Bergman
- Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia,Department of Paediatric Endocrinology & DiabetesMonash Children's HospitalMelbourneVictoriaAustralia
| | - Komal A Vora
- Department of Paediatric Endocrinology and DiabetesJohn Hunter Children's HospitalNewcastleNew South WalesAustralia,School of Medicine and Public Health, University of NewcastleCallaghanNew South WalesAustralia
| | - Patricia Crock
- Department of Paediatric Endocrinology and DiabetesJohn Hunter Children's HospitalNewcastleNew South WalesAustralia
| | - Charles F Verge
- Department of EndocrinologySydney Children's HospitalRandwickNew South WalesAustralia,School of Women's and Children's Health, The University of New South WalesSydneyNew South WalesAustralia
| | - Elaine Tham
- Endocrinology and Diabetes DepartmentWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Yassmin Musthaffa
- School of Clinical Medicine, University of QueenslandBrisbaneQueenslandAustralia,Department of Endocrinology and DiabetesQueensland Children's HospitalBrisbaneQueenslandAustralia,Department of PaediatricsLogan HospitalBrisbaneQueenslandAustralia
| | - Antony R Lafferty
- Department of Endocrinology and DiabetesCanberra HospitalGarranAustralian Capital TerritoryAustralia,Medical School, Australian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Peter Jacoby
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western AustraliaPerthWestern AustraliaAustralia
| | - Andrew C Wilson
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western AustraliaPerthWestern AustraliaAustralia,Respiratory and Sleep Medicine, Perth Children's HospitalPerthWestern AustraliaAustralia,Faculty of Medicine and Health SciencesThe University of Western AustraliaPerthWestern AustraliaAustralia,School of Physiotherapy and Exercise Science, Curtin UniversityPerthWestern AustraliaAustralia
| | - Jenny Downs
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western AustraliaPerthWestern AustraliaAustralia,School of Physiotherapy and Exercise Science, Curtin UniversityPerthWestern AustraliaAustralia
| | - Catherine S Choong
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western AustraliaPerthWestern AustraliaAustralia,Department of EndocrinologyPerth Children's HospitalPerthWestern AustraliaAustralia
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12
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Ingram DG, Arganbright JM, Paprocki E, Halpin KL. Sleep Disorders in Children with Prader Willi Syndrome: Current Perspectives. Nat Sci Sleep 2022; 14:2065-2074. [PMID: 36394064 PMCID: PMC9662031 DOI: 10.2147/nss.s361518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Children with Prader-Willi syndrome (PWS) face a multitude of potential health challenges including life-threatening obesity, endocrinopathies, behavioral and emotional dysregulation, developmental delays, and sleep disorders. In the current perspective piece, we provide a focused review of the condition's etiology and clinical findings, as well as a more in-depth discussion of sleep disorders frequently associated with PWS. In particular, we highlight and discuss difficult clinical scenarios frequently encountered by the pediatric sleep physician caring for this patient population, including diagnosis and treatment of complex sleep-related breathing disorders, considerations for sleep apnea surgery, the interplay between growth hormone and sleep apnea, diagnostic challenges in hypersomnia/narcolepsy, and current and emerging therapies for hypersomnia/narcolepsy. Overall, although there are many areas that need further research, sleep disorders remain a fruitful target for improving quality of life of children with PWS and their families.
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Affiliation(s)
- David G Ingram
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO, USA
| | - Jill M Arganbright
- Division of Pediatric Otolaryngology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Emily Paprocki
- Division of Pediatric Endocrinology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Kelsee L Halpin
- Division of Pediatric Endocrinology, Children's Mercy Hospital, Kansas City, MO, USA
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13
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Schaefer J, Davey MJ, Nixon GM. Sleep-disordered breathing in school-aged children with Prader-Willi Syndrome. J Clin Sleep Med 2021; 18:1055-1061. [PMID: 34870583 DOI: 10.5664/jcsm.9788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Studies of sleep-disordered breathing (SDB) in children with Prader-Willi syndrome (PWS) have focused on early childhood and growth hormone (GH)-naïve children, but little is known about older children, including those on long term GH therapy. This study aimed to describe the nature and prevalence of SDB in school-aged children with PWS in the growth hormone era. METHODS This retrospective single-center chart review included children aged 6-18 years with PWS who had overnight polysomnography not involving respiratory support over five years (2012-2017). The main outcome measures were the presence of obstructive sleep apnea, central sleep apnea or hypoventilation defined by an elevated PCO2 as per standard pediatric criteria. RESULTS Seventeen children (8 male, median age 11.6y, range 6.6-16.1y) were included. Fifteen demonstrated SDB of different types: central sleep apnea (18%), obstructive sleep apnea (24%), both obstructive and central sleep apnea (29%), or hypoventilation without obstructive or central sleep apnea (18%). Twelve (71%) children had evidence of hypoventilation. Those with hypoventilation had a higher central apnea-hypopnea index (AHI) but no difference in the obstructive AHI, age, sex, growth parameters, or the presence of scoliosis or sleep-related symptoms compared to those without hypoventilation. CONCLUSIONS Sleep-related hypoventilation is common in school-aged children with PWS. The presence of central sleep apnea, including the quantification of central hypopneas, but not obstructive sleep apnea or clinical factors predicted the presence of hypoventilation. Long-term polysomnography surveillance in children with PWS should include identification of central hypopneas and measurement of continuous pCO2.
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Affiliation(s)
- Jennifer Schaefer
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia
| | - Margot J Davey
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Gillian M Nixon
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
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14
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Sleep disordered breathing in patients with Prader willi syndrome: Impact of underlying genetic mechanism. Respir Med 2021; 187:106567. [PMID: 34411906 DOI: 10.1016/j.rmed.2021.106567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/05/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Sleep-disordered breathing (SDB) is common in children with PWS. In the current study, we aimed to evaluate the severity of SDB in patients with PWS using polysomnography (PSG), and assess the effect of the underlying genetic mechanism on PSG parameters. METHODS Children with PWS, referred to our sleep laboratory between March 2016 and January 2020 were enrolled. PSG parameters, demographic data, body mass index (BMI), and symptoms related to SDB were recorded. The effect of non-invasive ventilation strategies and the outcome of therapy on PSG parameters were evaluated. RESULTS In our study, 64.5% of the patients had severe sleep apnea syndrome (total apnea hypopnea index (AHI) ≥10 events/hour). 22.6% had significantly high (>5 events/hour) central sleep apnea. Patients with a deletion had significantly lower initial and mean SaO2, longer sleep time SaO2 under 90%, oxygen desaturation % and total AHI when compared to those with uniparental disomy. PSG parameters were similar between patients who did or didn't receive growth hormone treatment. CONCLUSION The majority of the PWS patients had severe sleep apnea syndrome characterized mainly by hypopneas which were accompanied by central apneas. There was a more severe impact on oxygen parameters and total AHI in patients with deletions.
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15
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Shukur HH, Hussain-Alkhateeb L, Farholt S, Nørregaard O, Jørgensen AP, Hoybye C. Effects of Growth Hormone Treatment on Sleep-Related Parameters in Adults With Prader-Willi Syndrome. J Clin Endocrinol Metab 2021; 106:e3634-e3643. [PMID: 33950234 PMCID: PMC8372636 DOI: 10.1210/clinem/dgab300] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT Prader-Willi syndrome (PWS) is a rare, genetic, multisymptom, neurodevelopmental disease due to lack of the expression of the paternal genes in the q11 to q13 region of chromosome 15. The main characteristics of PWS are muscular hypotonia, hyperphagia, obesity, behavioral problems, cognitive disabilities, and endocrine deficiencies, including growth hormone (GH) deficiency. Sleep apnea and abnormal sleep patterns are common in PWS. GH treatment might theoretically have a negative impact on respiration. OBJECTIVE Here we present the effect of GH treatment on polysomnographic measurements. METHODS Thirty-seven adults, 15 men and 22 women, with confirmed PWS were randomly assigned to 1 year of GH treatment (n = 19) or placebo (n = 18) followed by 2 years of GH treatment to all. Polysomnographic measurements were performed every 6 months. A mixed-effect regression model was used for comparison over time in the subgroup that received GH for 3 years. RESULTS At baseline median age was 29.5 years, body mass index 27.1, insulin-like growth factor 115 µg/L, apnea-hypopnea index (AHI) 1.4 (range, 0.0-13.9), and sleep efficiency (SE) 89.0% (range, 41.0%-99.0%). No differences in sleep or respiratory parameters were seen between GH- and placebo-treated patients. SE continuously improved throughout the study, also after adjustment for BMI, and the length of the longest apnea increased. AHI inconsistently increased within normal range. CONCLUSION SE improved during GH treatment and no clinical, significantly negative impact on respiration was seen. The etiology of breathing disorders is multifactorial and awareness of them should always be present in adults with PWS with or without GH treatment.
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Affiliation(s)
- Hasanain Hamid Shukur
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Solna SE-171 76, Sweden
- Correspondence: Hasanain Hamid Shukur, MD, Department of Molecular Medicine and Surgery, Karolinska Institute, L1:00, Anna Steckséns gata 53, Stockholm, Solna SE-171 76, Sweden.
| | - Laith Hussain-Alkhateeb
- Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Stense Farholt
- Center for Rare Diseases, Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Ole Nørregaard
- Danish Respiratory Center West, Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Anders Palmstrøm Jørgensen
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway
| | - Charlotte Hoybye
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Solna SE-171 76, Sweden
- Department of Endocrinology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
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16
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Zimmermann M, Laemmer C, Woelfle J, Fimmers R, Gohlke B. Sleep-Disordered Breathing in Children with Prader-Willi Syndrome in Relation to Growth Hormone Therapy Onset. Horm Res Paediatr 2021; 93:85-93. [PMID: 32535587 DOI: 10.1159/000506943] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/29/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to consider sleep apnea in Prader-Willi syndrome (PWS) children depending on age at growth hormone (GH) therapy onset. STUDY DESIGN We analyzed longitudinally cardiorespiratory polygraphy of 62 PWS children (aged 0-2.5 years at baseline). Twenty-one children (Group A) started GH-therapy during and 41 children (Group B) after their first year of life. Data were acquired before, at 3 and 6 months, then 1.2, 2.2, and 3.2 years after GH onset. Outcomes were determined with the obstructive apnea hypopnea index (OAHI), central apnea index (CAI), oxygen desaturation index (ODI), and by measuring obstructive sleep apnea (OSA) and peripheral blood oxygen saturation (SpO2). RESULTS We observed no significant differences in OAHI, CAI, ODI, and SpO2 depending on treatment onset. At baseline, 5/21 patients (23.8%) in Group A versus 15/41 patients (36.6%) in Group B showed pathological sleep apnea (OAHI ≥1.5). Pathological OSA increased significantly in Group A during the first 3 months of therapy but dropped below baseline after 1 year in both groups. ODI changed during GH therapy in both groups (from 4.0 to 2.6 in Group A, and 3.6 to 1.6 in Group B; baseline to 3.2 years; p < 0.05). CONCLUSIONS OSA in PWS children appears to develop independently of treatment onset. Treatment may therefore safely be initiated early but should be accompanied by regular sleep analysis.
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Affiliation(s)
- Maja Zimmermann
- Pediatric Endocrinology and Diabetology, Children's Hospital, University of Bonn, Bonn, Germany
| | - Constanze Laemmer
- Pediatric Endocrinology and Diabetology, St. Bernward Hospital, Hildesheim, Germany
| | | | - Rolf Fimmers
- University Hospital of Bonn, Institute for Medical Biometry, Bonn, Germany
| | - Bettina Gohlke
- Pediatric Endocrinology and Diabetology, Children's Hospital, University of Bonn, Bonn, Germany,
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17
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Comparison of Frequency and Severity of Sleep-Related Breathing Disorders in Children with Simple Obesity and Paediatric Patients with Prader-Willi Syndrome. J Pers Med 2021; 11:jpm11020141. [PMID: 33670584 PMCID: PMC7923084 DOI: 10.3390/jpm11020141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 12/02/2022] Open
Abstract
Sleep-related breathing disorders (SRBDs) can be present in children with simple obesity and with Prader–Willi syndrome (PWS) and influence an individual diagnostic and treatment approach. We compared frequency and severity of SRBDs in children with simple obesity and with PWS, both without and on recombinant human growth hormone (rhGH) treatment, and correlation of SRBDs with insulin resistance tests. A screening polysomnography-polygraphy (PSG), the oral glucose tolerance test (OGTT) and homeostasis model assessment of insulin resistance (HOMA-IR) were analysed in three groups of patients—with simple obesity (group 1, n = 30, mean age 14.2 years), patients with PWS without the rhGH therapy (group 2, n = 8, mean age 13.0 years) and during the rhGH treatment (group 3, n = 17, mean age 8.9 years). The oxygen desaturation index (ODI) was significantly higher in groups 2 and 3, compared to group 1 (p = 0.00), and hypopnea index (HI) was higher in group 1 (p = 0.03). Apnea–hypopnea index (AHI) and apnea index (AI) results positively correlated with the insulin resistance parameters in groups 1 and 3. The PSG values worsened along with the increasing insulin resistance in children with simple obesity and patients with PWS treated with rhGH that may lead to a change in the patients’ care.
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18
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Cataldi M, Arnaldi D, Tucci V, De Carli F, Patti G, Napoli F, Pace M, Maghnie M, Nobili L. Sleep disorders in Prader-Willi syndrome, evidence from animal models and humans. Sleep Med Rev 2021; 57:101432. [PMID: 33567377 DOI: 10.1016/j.smrv.2021.101432] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023]
Abstract
Prader-Willi Syndrome (PWS) is a complex genetic disorder with multiple cognitive, behavioral and endocrine dysfunctions. Sleep alterations and sleep disorders such as Sleep-disordered breathing and Central disorders of hypersomnolence are frequently recognized (either isolated or in comorbidity). The aim of the review is to highlight the pathophysiology and the clinical features of sleep disorders in PWS, providing the basis for early diagnosis and management. We reviewed the genetic features of the syndrome and the possible relationship with sleep alterations in animal models, and we described sleep phenotypes, diagnostic tools and therapeutic approaches in humans. Moreover, we performed a meta-analysis of cerebrospinal fluid orexin levels in patients with PWS; significantly lower levels of orexin were detected in PWS with respect to control subjects (although significantly higher than the ones of narcoleptic patients). Sleep disorders in humans with PWS are multifaceted and are often the result of different mechanisms. Since hypothalamic dysfunction seems to partially influence metabolic, respiratory and sleep/wake characteristics of this syndrome, additional studies are required in this framework.
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Affiliation(s)
- Matteo Cataldi
- Unit of Child Neuropsychiatry, Department of Medical and Surgical Neuroscience and Rehabilitation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Dario Arnaldi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Valter Tucci
- Genetics and Epigenetics of Behaviour Laboratory, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Fabrizio De Carli
- Institute of Bioimaging and Molecular Physiology, National Research Council, Genoa, Italy
| | - Giuseppa Patti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Department of Pediatrics, Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Flavia Napoli
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Marta Pace
- Genetics and Epigenetics of Behaviour Laboratory, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Mohamad Maghnie
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Department of Pediatrics, Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Lino Nobili
- Unit of Child Neuropsychiatry, Department of Medical and Surgical Neuroscience and Rehabilitation, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
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19
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Kim JH, Choi YJ, Kim MJ, Park JS, Jeon MJ, Suh DI. Descriptive analysis on sleep-disordered breathing in children with Prader-Willi syndrome. ALLERGY ASTHMA & RESPIRATORY DISEASE 2021. [DOI: 10.4168/aard.2021.9.4.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ji Hye Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jung Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Soo Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Min Jin Jeon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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20
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Chung MS, Langouët M, Chamberlain SJ, Carmichael GG. Prader-Willi syndrome: reflections on seminal studies and future therapies. Open Biol 2020; 10:200195. [PMID: 32961075 PMCID: PMC7536080 DOI: 10.1098/rsob.200195] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
Prader-Willi syndrome (PWS) is caused by the loss of function of the paternally inherited 15q11-q13 locus. This region is governed by genomic imprinting, a phenomenon in which genes are expressed exclusively from one parental allele. The genomic imprinting of the 15q11-q13 locus is established in the germline and is largely controlled by a bipartite imprinting centre. One part, termed the Prader-Willi syndrome imprinting center (PWS-IC), comprises a CpG island that is unmethylated on the paternal allele and methylated on the maternal allele. The second part, termed the Angelman syndrome imprinting centre, is required to silence the PWS_IC in the maternal germline. The loss of the paternal contribution of the imprinted 15q11-q13 locus most frequently occurs owing to a large deletion of the entire imprinted region but can also occur through maternal uniparental disomy or an imprinting defect. While PWS is considered a contiguous gene syndrome based on large-deletion and uniparental disomy patients, the lack of expression of only non-coding RNA transcripts from the SNURF-SNRPN/SNHG14 may be the primary cause of PWS. Patients with small atypical deletions of the paternal SNORD116 cluster alone appear to have most of the PWS related clinical phenotypes. The loss of the maternal contribution of the 15q11-q13 locus causes a separate and distinct condition called Angelman syndrome. Importantly, while much has been learned about the regulation and expression of genes and transcripts deriving from the 15q11-q13 locus, there remains much to be learned about how these genes and transcripts contribute at the molecular level to the clinical traits and developmental aspects of PWS that have been observed.
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Affiliation(s)
| | | | | | - Gordon G. Carmichael
- Department of Genetics and Genome Sciences, UCONN Health, 400 Farmington Avenue, Farmington, CT 06030, USA
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21
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Clements AC, Dai X, Walsh JM, Sterni LM, Prichett L, Boss EF, Seal SM, Ryan MA. Outcomes of Adenotonsillectomy for Obstructive Sleep Apnea in Prader-Willi Syndrome: Systematic Review and Meta-analysis. Laryngoscope 2020; 131:898-906. [PMID: 33026674 DOI: 10.1002/lary.28922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/27/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Prader-Willi syndrome (PWS) increases the risk of obstructive sleep apnea (OSA) due to obesity, hypotonia, and abnormal ventilatory responses. We evaluated post-adenotonsillectomy complications, polysomnography changes, and quality of life in children with OSA and PWS. STUDY DESIGN Systematic review and meta-analysis. METHODS We conducted a systematic review and meta-analysis by searching PubMed, Embase, Cochrane, Web of Science, and Scopus. Two researchers independently reviewed studies about adenotonsillectomy for OSA in patients <21 years with PWS. We extracted study design, patient numbers, age, complications, polysomnography, and quality of life. We pooled postoperative changes in apnea hypopnea index (AHI) for meta-analysis. We applied Methodological Index for Nonrandomized Studies (MINORS) criteria to assess study quality. RESULTS The initial search yielded 169 studies. We included 68 patients from eight studies with moderate to high risk of bias. Six studies reported on complications and 12 of 51 patients (24%) had at least one. Velopharyngeal insufficiency was the most commonly reported complication (7/51, 14%). We included seven studies in meta-analysis. Mean postoperative improvement in AHI was 7.7 (95% CI: 4.9-10.5). Postoperatively 20% (95% CI: 3%-43%) had resolution of OSA with AHI < 1.5 while 67% (95% CI: 50%-82%) had improvement from severe/moderate OSA to mild/resolved (AHI < 5). Two studies evaluated quality of life and demonstrated improvement. CONCLUSIONS Children with PWS undergoing adenotonsillectomy for OSA have a substantial risk of postoperative complications that may require additional interventions, especially velopharyngeal insufficiency. Despite improvements in polysomnography and quality of life, many patients had residual OSA. This information can be used to counsel families when considering OSA treatment options. Laryngoscope, 131:898-906, 2021.
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Affiliation(s)
| | - Xi Dai
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Jonathan M Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Laura M Sterni
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Laura Prichett
- Biostatistics, Epidemiology and Data Management (BEAD) Core, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Stella M Seal
- Johns Hopkins University School of Medicine, Welch Medical Library, Baltimore, Maryland, U.S.A
| | - Marisa A Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
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22
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Lee CH, Hsu WC, Ko JY, Yeh TH, Lin MT, Kang KT. Adenotonsillectomy for the Treatment of Obstructive Sleep Apnea in Children with Prader-Willi Syndrome: A Meta-analysis. Otolaryngol Head Neck Surg 2019; 162:168-176. [DOI: 10.1177/0194599819893115] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective Adenotonsillectomy outcomes in obstructive sleep apnea (OSA) treatment among children with Prader-Willi syndrome (PWS) remain unclear. This study aimed to elucidate the effectiveness of adenotonsillectomy in OSA treatment among children with PWS. Data Source PubMed, MEDLINE, Embase, and Cochrane Review up to February 2019. Review Methods The registry number of the protocol published on PROSPERO was CRD42015027053. Two authors independently searched the relevant database. Polysomnography outcomes in these children were examined, including net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum and mean oxygen saturation, the overall success rate for a postoperative AHI <1, and the overall success rate for a postoperative AHI <5. Results Six studies with 41 patients were analyzed (mean age, 5.0 years; 55% boys; mean sample size, 6.8 patients). All children had PWS and received adenotonsillectomy for the treatment of OSA. The AHI was 13.1 events per hour (95% CI, 11.0-15.1) before surgery and 4.6 events per hour (95% CI, 4.1-5.1) after surgery. The mean change in the AHI was a significant reduction of 8.0 events per hour (95% CI, −10.8 to −5.1). The overall success rate was 21% (95% CI, 11%-38%) for a postoperative AHI <1 and 71% (95% CI, 54%-83%) for a postoperative AHI <5. Some patients developed velopharyngeal insufficiency postoperatively. Conclusion Adenotonsillectomy was associated with OSA improvement among children with PWS. However, residual OSA was frequently observed postoperatively in these patients.
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Affiliation(s)
- Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City
- Department of Otolaryngology, National Taiwan University Hospital, Taipei
- Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei
- Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei
- Sleep Center, National Taiwan University Hospital, Taipei
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital, Taipei
- Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, Taipei
- Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei
| | - Ming-Tzer Lin
- Sleep Center, National Taiwan University Hospital, Taipei
- Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City
| | - Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City
- Department of Otolaryngology, National Taiwan University Hospital, Taipei
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Palmieri VV, Lonero A, Bocchini S, Cassano G, Convertino A, Corica D, Crinò A, Fattorusso V, Ferraris S, Fintini D, Franzese A, Grugni G, Iughetti L, Lia R, Macchi F, Madeo SF, Matarazzo P, Nosetti L, Osimani S, Pajno R, Patti G, Pellegrin MC, Perri A, Ragusa L, Rutigliano I, Sacco M, Salvatoni A, Scarano E, Stagi S, Tornese G, Trifirò G, Wasniewska M, Fischetto R, Giordano P, Licenziati MR, Delvecchio M. Uniparental disomy and pretreatment IGF-1 may predict elevated IGF-1 levels in Prader-Willi patients on GH treatment. Growth Horm IGF Res 2019; 48-49:9-15. [PMID: 31487604 DOI: 10.1016/j.ghir.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/09/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
Pediatric patients with Prader-Willi syndrome (PWS) can be treated with recombinant human GH (rhGH). These patients are highly sensitive to rhGH and the standard doses suggested by the international guidelines often result in IGF-1 above the normal range. We aimed to evaluate 1 the proper rhGH dose to optimize auxological outcomes and to avoid potential overtreatment, and 2 which patients are more sensitive to rhGH. In this multicenter real-life study, we recruited 215 patients with PWS older than 1 year, on rhGH at least for 6 months, from Italian Centers for PWS care. We collected auxological parameters, rhGH dose, IGF-1 at recruitment and (when available) at start of treatment. The rhGH dose was 4.3 (0.7/8.4) mg/m2/week. At recruitment, IGF-1 was normal in 72.1% and elevated in 27.9% of the patients. In the group of 115 patients with IGF-1 available at start of rhGH, normal pretreatment IGF-1 and uniparental disomy were associated with elevated IGF-1 during the therapy. No difference in height and growth velocity was found between patients treated with the highest and the lowest range dose. The rhGH dose prescribed in Italy seems lower than the recommended one. Normal pretreatment IGF-1 and uniparental disomy are risk factors for elevated IGF-1. The latter seems to be associated with higher sensitivity to GH. In case of these risk factors, we recommend a more accurate titration of the dose to avoid overtreatment and its potential side effects.
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Affiliation(s)
- Viviana Valeria Palmieri
- Department of Biomedicine and Human Oncology, Pediatric Section, University A. Moro, Bari, Italy
| | | | - Sarah Bocchini
- Reference Center for Prader-Willi syndrome, Bambino Gesù Hospital, Research Hospital, Roma, Italy
| | - Gilda Cassano
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessio Convertino
- Reference Center for Prader-Willi syndrome, Bambino Gesù Hospital, Research Hospital, Roma, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Italy
| | - Antonio Crinò
- Reference Center for Prader-Willi syndrome, Bambino Gesù Hospital, Research Hospital, Roma, Italy
| | | | - Silvio Ferraris
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, University of Torino, Torino, Italy
| | - Danilo Fintini
- Reference Center for Prader-Willi syndrome, Bambino Gesù Hospital, Research Hospital, Roma, Italy
| | - Adriana Franzese
- Department of Translational Sciences, University Federico II, Naples, Italy
| | - Graziano Grugni
- Division of Auxology, Italian Auxological Institute, Research Institute, Piancavallo, Verbania, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Francesca Macchi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Simona Filomena Madeo
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, University of Torino, Torino, Italy
| | - Luana Nosetti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Sara Osimani
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta Pajno
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppa Patti
- Department of Pediatrics, Giannina Gaslini Institute, Genoa, Italy
| | | | - Annamaria Perri
- Rare Diseases Unit Pediatric Department, University of Bologna, Bologna, Italy
| | | | - Irene Rutigliano
- Department of Pediatrics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Michele Sacco
- Department of Pediatrics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Emanuela Scarano
- Rare Diseases Unit Pediatric Department, University of Bologna, Bologna, Italy
| | - Stefano Stagi
- Anna Meyer Children's University Hospital, Florence, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Italy
| | - Rita Fischetto
- Metabolic Diseases, Clinical Genetics and Diabetology Unit, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Paola Giordano
- Department of Biomedicine and Human Oncology, Pediatric Section, University A. Moro, Bari, Italy
| | - Maria Rosaria Licenziati
- Obesity and Endocrine disease Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maurizio Delvecchio
- Metabolic Diseases, Clinical Genetics and Diabetology Unit, Giovanni XXIII Children's Hospital, Bari, Italy.
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Donze SH, de Weerd AW, van den Bossche RAS, Joosten KFM, Hokken-Koelega ACS. Sleep-related breathing disorders in young adults with Prader-Willi syndrome: a placebo-controlled, cross-over GH trial. J Clin Endocrinol Metab 2019; 104:3931-3938. [PMID: 30998237 DOI: 10.1210/jc.2019-00391] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/11/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT Sleep-related breathing disorders (SRBD) are common in people with Prader-Willi syndrome (PWS). Young adults with PWS benefit from GH continuation after adult height by maintaining the improved body composition obtained during childhood. There are, however, no studies about the effects of GH on SRBD in young adults with PWS who were treated with GH during childhood. OBJECTIVE To investigate the effects of GH versus placebo on SRBD in young adults with PWS who were treated with GH during childhood and had attained adult height. DESIGN 2-year, randomized, double-blind, placebo-controlled, cross-over GH-study in 27 young adults with PWS, stratified for gender and BMI. SETTING Dutch PWS Reference Center. INTERVENTION Cross-over intervention with GH (0.67 mg/m2/day) and placebo, both during one year. MAIN OUTCOME MEASURES Apnea hypopnea index (AHI), obstructive apnea index (OAI), central apnea index (CAI), measured by polysomnography. RESULTS Compared to placebo, GH treatment did not increase AHI, CAI or OAI (p>0.35). The effect of GH versus placebo was neither different between men and women, nor between patients with a deletion or mUPD/ICD. After 2 years, there was no difference in AHI, CAI or OAI compared to baseline (p>0.18). Two patients (7%) fulfilled the criteria of obstructive sleep apnea (OSA), regardless of GH or placebo. CONCLUSIONS GH compared to placebo does not cause a significant increase in AHI, CAI or OAI in adults with PWS who were treated with GH during childhood and have attained adult height. Our findings are reassuring and prove that GH can be safely administered.
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Affiliation(s)
- Stephany H Donze
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Erasmus University Medical Center/Sophia Children's Hospital, Department of Pediatrics, Subdivision of Endocrinology, Rotterdam, The Netherlands
| | | | | | - Koen F M Joosten
- Erasmus University Medical Center/Sophia Children's Hospital, Department of Pediatrics, Intensive Care Unit, Rotterdam, The Netherlands
| | - Anita C S Hokken-Koelega
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Erasmus University Medical Center/Sophia Children's Hospital, Department of Pediatrics, Subdivision of Endocrinology, Rotterdam, The Netherlands
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Abel F, Tan HL, Negro V, Bridges N, Carlisle T, Chan E, Laverty A, Miligkos M, Samuels M, Kaditis AG. Hypoventilation disproportionate to OSAS severity in children with Prader-Willi syndrome. Arch Dis Child 2019; 104:166-171. [PMID: 30007944 DOI: 10.1136/archdischild-2017-314282] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 06/16/2018] [Accepted: 06/20/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To test the hypothesis that children with Prader-Willi syndrome (PWS) and obstructive sleep apnoea syndrome (OSAS) have hypercapnia for higher proportion of total sleep time (TST) than non-syndromic children with similar obstructive apnoea-hypopnoea index (OAHI). DESIGN Cross-sectional study. SETTING Two tertiary care hospitals. PATIENTS Patients with PWS and non-syndromic children with snoring who underwent polygraphy and were of similar age, body mass index (BMI) z-score and OAHI. MAIN OUTCOME MEASURE The two groups were compared regarding %TST with transcutaneous CO2 (PtcCO2) >50 mm Hg. The interaction between PWS diagnosis and OSAS severity (OAHI <1 episode/h vs 1-5 episodes/h vs >5 episodes/h) regarding %TST with PtcCO2 >50 mm Hg was tested using multiple linear regression. RESULTS 48 children with PWS and 92 controls were included (median age 2.3 (range 0.2-14.1) years vs 2.2 (0.3-15.1) years; BMI z-score 0.7±1.9 vs 0.8±1.7; median OAHI 0.5 (0-29.5) episodes/h vs 0.5 (0-33.9) episodes/h; p>0.05). The two groups did not differ in %TST with PtcCO2 >50 mm Hg (median 0% (0-100%) vs 0% (0-81.3%), respectively; p>0.05). However, the interaction between PWS and OSAS severity with respect to duration of hypoventilation was significant (p<0.01); the estimated mean differences of %TST with PtcCO2 >50 mm Hg between children with PWS and controls for OAHI <1 episode/h, 1-5 episodes/h and >5 episodes/h were +0.2%, +1% and +33%, respectively. CONCLUSION Increasing severity of upper airway obstruction during sleep in children with PWS is accompanied by disproportionately longer periods of hypoventilation when compared with non-syndromic children with similar frequency of obstructive events.
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Affiliation(s)
- Francois Abel
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | - Hui-Leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Valentina Negro
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Nicola Bridges
- Department of Paediatric Endocrinology, Chelsea and Westminster Hospital, London, UK
| | - Thomas Carlisle
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Elaine Chan
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | - Aidan Laverty
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | - Michael Miligkos
- Paediatric Pulmonology Unit, First Department of Paediatrics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.,Department of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece
| | - Martin Samuels
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | - Athanasios G Kaditis
- Paediatric Pulmonology Unit, First Department of Paediatrics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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Costa RA, Ferreira IR, Cintra HA, Gomes LHF, Guida LDC. Genotype-Phenotype Relationships and Endocrine Findings in Prader-Willi Syndrome. Front Endocrinol (Lausanne) 2019; 10:864. [PMID: 31920975 PMCID: PMC6923197 DOI: 10.3389/fendo.2019.00864] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a complex imprinting disorder related to genomic errors that inactivate paternally-inherited genes on chromosome 15q11-q13 with severe implications on endocrine, cognitive and neurologic systems, metabolism, and behavior. The absence of expression of one or more genes at the PWS critical region contributes to different phenotypes. There are three molecular mechanisms of occurrence: paternal deletion of the 15q11-q13 region; maternal uniparental disomy 15; or imprinting defects. Although there is a clinical diagnostic consensus criteria, DNA methylation status must be confirmed through genetic testing. The endocrine system can be the most affected in PWS, and growth hormone replacement therapy provides improvement in growth, body composition, and behavioral and physical attributes. A key feature of the syndrome is the hypothalamic dysfunction that may be the basis of several endocrine symptoms. Clinical and molecular complexity in PWS enhances the importance of genetic diagnosis in therapeutic definition and genetic counseling. So far, no single gene mutation has been described to contribute to this genetic disorder or related to any exclusive symptoms. Here we proposed to review individually disrupted genes within the PWS critical region and their reported clinical phenotypes related to the syndrome. While genes such as MKRN3, MAGEL2, NDN, or SNORD115 do not address the full spectrum of PWS symptoms and are less likely to have causal implications in PWS major clinical signs, SNORD116 has emerged as a critical, and possibly, a determinant candidate in PWS, in the recent years. Besides that, the understanding of the biology of the PWS SNORD genes is fairly low at the present. These non-coding RNAs exhibit all the hallmarks of RNA methylation guides and can be incorporated into ribonucleoprotein complexes with possible hypothalamic and endocrine functions. Also, DNA conservation between SNORD sequences across placental mammals strongly suggests that they have a functional role as RNA entities on an evolutionary basis. The broad clinical spectrum observed in PWS and the absence of a clear genotype-phenotype specific correlation imply that the numerous genes involved in the syndrome have an additive deleterious effect on different phenotypes when deficiently expressed.
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27
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Obstructive events in children with Prader-Willi syndrome occur predominantly during rapid eye movement sleep. Sleep Med 2018; 54:43-47. [PMID: 30529776 DOI: 10.1016/j.sleep.2018.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/26/2018] [Accepted: 09/29/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Children with Prader-Willi syndrome (PWS) have a high prevalence of obstructive sleep apnea syndrome (OSAS). In most typically developing children with OSAS, more obstructive apneas and hypopneas occur during rapid eye movement (REM) than during non-REM (NREM) sleep. It was hypothesized that patients with PWS are even more prone to obstructive events in REM sleep than otherwise healthy subjects with OSAS. METHODS Polysomnographic data of patients with PWS and of typically developing children (controls) with OSAS (apnea-hypopnea index [AHI] > 1 episode/h) were analyzed. The two groups were compared regarding obstructive AHI (OAHI), OAHI during NREM sleep (OAHInrem), OAHI during REM sleep (OAHIrem), and the OAHIrem/OAHI ratio (outcome measures). The association between PWS diagnosis and OAHIrem/OAHI was adjusted for confounders using a general linear model. RESULTS Twelve children with PWS (median age 7.1 years [interquartile range 3.5, 12.4 years]) and 53 controls (6.5 years [3.9, 8.7 years]) were studied. Children with PWS and controls were similar regarding OAHI (p = 0.21) and OAHInrem (p = 0.76). However, subjects with PWS had higher OAHIrem (17.6 episodes/h [5.8, 25.8 episodes/h]) and OAHIrem/OAHI (2.3 [1.5, 3.2]) than controls (5 episodes/h [1.5, 8.1 episodes/h]; p = 0.002 and 1 [0.5, 2]; p = 0.003, respectively). The association between PWS diagnosis and higher OAHIrem/OAHI persisted after adjustment for age, gender, and obesity (p = 0.009). CONCLUSION In children with PWS, OAHI calculated for total sleep time does not reflect OSAS severity during REM sleep, which on average can be twice as high. Mild OSAS in patients with PWS demonstrated by polygraphy without sleep staging may correspond to a moderately-to-severely increased OAHIrem.
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28
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Stipančić G, Požgaj Šepec M, La Grasta Sabolić L. EFFECT OF GROWTH HORMONE THERAPY IN CHILDREN WITH PRADER-WILLI SYNDROME - OUR FIRST EXPERIENCES. Acta Clin Croat 2018; 57:744-755. [PMID: 31168212 PMCID: PMC6544111 DOI: 10.20471/acc.2018.57.04.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 03/15/2018] [Indexed: 11/24/2022] Open
Abstract
- Prader-Willi syndrome (PWS) is the most common cause of morbid obesity in childhood. It is the consequence of the lack of expression of genes on the paternally inherited 15q11.2-q13 region. Hyperphagia, obesity, short stature, psychomotor retardation and deterioration of behavior predominate in clinical presentation. Recombinant human growth hormone (rhGH) therapy, along with restriction of caloric intake, has become the mainstay in the management of PWS patients. Anthropometric parameters (height, body mass index (BMI)), therapy effect on carbohydrate and lipid metabolism, and occurrence of side effects were monitored in four children with PWS treated with rhGH for ≥2 years at doses of up to 1 mg/m2/day. During the follow-up, the height standard deviation score (SDS) increased in comparison with baseline values, and after ≥2 years of treatment with rhGH it was within the reference range for the general children population. BMI SDS decreased after the first year of treatment, but thereafter increased again; still, the level of BMI SDS was much better in comparison with most children with PWS of the same age and gender. RhGH therapy had no negative effect on glucose and lipid metabolism, nor caused any other adverse effect. Therapy including a customized diet for PWS, along with rhGH therapy, provided a satisfactory growth rate and prevented development of morbid obesity without side effects. This treatment approach would ensure transition of a greater number of PWS patients into adult care, where the multidisciplinary approach in care should be continued.
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Moix Gil E, Giménez-Palop O, Caixàs A. Treatment with growth hormone in the prader-willi syndrome. ACTA ACUST UNITED AC 2018; 65:229-236. [PMID: 29510967 DOI: 10.1016/j.endinu.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/07/2018] [Accepted: 01/10/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The Prader-Willi syndrome (PWS) is a rare genetic disorder caused by absence of expression of the paternal alleles in región 15q11.2-q13. Obesity and hormonal deficiencies, especially of growth hormone (GH), are the most important signs from the therapeutic viewpoint. Recombinant GH (rGH) is effective in children and represents the mainstay in treatment; by contrast, little evidence in available in adult patients. OBJECTIVE To review the reported evidence on the beneficial and adverse effects of treatment with rGH in children and adults. DESIGN A review was made of 62 original articles published between 2000 and 2017 using the PubMed database. RESULTS In pediatric and adult PWS, rGH improves body morphology and composition, physical performance, cognition, psychomotor development, respiratory function, and quality of life with few adverse effects. CONCLUSIONS Treatment with rGH is effective and safe and improves quality of life in both children and adults with PWS.
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Affiliation(s)
- Eugènia Moix Gil
- Facultad de Medicina, Unidad Docente Parc Taulí, Universitat Autònoma de Barcelona, Barcelona, España
| | - Olga Giménez-Palop
- Servicio de Endocrinología y Nutrición, Hospital Universitari Parc Tauli, , Sabadell, España
| | - Assumpta Caixàs
- Servicio de Endocrinología y Nutrición, Hospital Universitari Parc Tauli, , Sabadell, España.
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McCarthy JM, McCann-Crosby BM, Rech ME, Yin J, Chen CA, Ali MA, Nguyen HN, Miller JL, Schaaf CP. Hormonal, metabolic and skeletal phenotype of Schaaf-Yang syndrome: a comparison to Prader-Willi syndrome. J Med Genet 2018; 55:307-315. [DOI: 10.1136/jmedgenet-2017-105024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/20/2017] [Accepted: 01/06/2018] [Indexed: 12/27/2022]
Abstract
BackgroundNonsense and frameshift mutations in the maternally imprinted, paternally expressed gene MAGEL2, located in the Prader-Willi critical region 15q11-15q13, have been reported to cause Schaaf-Yang syndrome (SYS), a genetic disorder that manifests as developmental delay/intellectual disability, hypotonia, feeding difficulties and autism spectrum disorder. Prader-Willi syndrome (PWS) is a genetic disorder characterised by severe infantile hypotonia, hypogonadotrophic hypogonadism, early childhood onset obesity/hyperphagia, developmental delay/intellectual disability and short stature. Scoliosis and growth hormone insufficiency are also prevalent in PWS.There is extensive documentation of the endocrine and metabolic phenotypes for PWS, but not for SYS. This study served to investigate the hormonal, metabolic and body composition phenotype of SYS and its potential overlap with PWS.MethodsIn nine individuals with SYS (5 female/4 male; aged 5–17 years), we measured serum ghrelin, glucose, insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3, follicle-stimulating hormone, luteinising hormone, thyroid-stimulating hormone, free T4, uric acid and testosterone, and performed a comprehensive lipid panel. Patients also underwent X-ray and dual-energy X-ray absorptiometry analyses to assess for scoliosis and bone mineral density.ResultsLow IGF-1 levels despite normal weight/adequate nutrition were observed in six patients, suggesting growth hormone deficiency similar to PWS. Fasting ghrelin levels were elevated, as seen in individuals with PWS. X-rays revealed scoliosis >10° in three patients, and abnormal bone mineral density in six patients, indicated by Z-scores of below −2 SDs.ConclusionThis is the first analysis of the hormonal, metabolic and body composition phenotype of SYS. Our findings suggest that there is marked, but not complete overlap between PWS and SYS.
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Ss M. A Pediatric Patient with Idiopathic Short Stature Who Developed Obstructive Sleep Apnea after Starting Growth Hormone Replacement Therapy. J Mol Genet Med 2018; 11. [PMID: 29399036 DOI: 10.4172/1747-0862.1000307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Growth hormone (GH) therapy has long been suspected to induce obstructive sleep apnea (OSA) in children and adults. Moreover, reports about GH-associated sudden death in children with Prader-Willi syndrome (PWS) have prompted concerns about GH worsening sleep apnea. Previous studies have supported routine polysomnography for children with PWS prior to starting GH treatments, regardless of clinical history. However, there are no established guidelines recommending routine polysomnography (PSG) prior to the commencement of GH therapy in other pediatric patients. Case description We report a case of a 15-year-old young man with intractable headaches, referred to the sleep clinic to rule out any sleep-related variables. After an initial non-significant (mild snoring) sleep study, the patient returned with worsening snoring about one year after starting GH therapy for concerns of short stature. Results A second polysomnogram revealed that his obstructive apnea-hypopnea index had risen dramatically from baseline. His symptoms resolved after tonsillectomy and adenoidectomy. Conclusion This interesting case highlights the need for caution with any patient eligible for GH therapy. We recommend additional research to look in the development of definitive guidelines regarding the indications for polysomnography for patients with idiopathic short stature and non-significant initial sleep history-particularly before and during the administration of GH therapy.
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Affiliation(s)
- Morkous Ss
- Department of Pediatrics, Pediatric Neurology Division, Lehigh Valley Children's Hospital, Allentown, PA, USA.,Pediatrics Core Academic Rank, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Clinical Sciences, DeSales University, Center Valley, PA, USA
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Abstract
Prader-Willi syndrome (PWS) is a complex genetic disorder with implications on the endocrine and neurologic systems, metabolism, and behavior. Early in life, PWS is characterized by hypotonia and failure to thrive, followed by obesity and hyperphagia. Patients with PWS develop hypothalamic dysfunction which may lead growth hormone deficiency (GHD), hypogonadism, hypothyroidism, adrenal insufficiency, and poor bone mineral density (BMD). In addition to hypothalamic dysfunction, individuals with PWS have increased risk for obesity which may be complicated by metabolic syndrome and type 2 diabetes mellitus (T2DM). In this paper, we will review the current literature pertaining to the endocrine concerns of PWS and current recommendations for screening and management of these conditions.
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Affiliation(s)
- Ryan Heksch
- Department of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Manmohan Kamboj
- Department of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kathryn Anglin
- Department of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kathryn Obrynba
- Department of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
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Tan HL, Urquhart DS. Respiratory Complications in Children with Prader Willi Syndrome. Paediatr Respir Rev 2017; 22:52-59. [PMID: 27839656 DOI: 10.1016/j.prrv.2016.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 01/31/2023]
Abstract
Prader Willi syndrome, resulting from the partial deletion or lack of expression of a region of genes on the paternal chromosome 15, has a number of phenotypic features which predispose affected patients to ventilatory problems. These include generalised hypotonia, abnormal arousal and ventilatory responses to hypoxia and hypercapnia, scoliosis and frequently, obesity. The spectrum of the resulting respiratory complications thus runs from sleep disordered breathing, to aspiration and respiratory functional impairment. While the use of growth hormone, in conjunction with multidisciplinary clinical management, is currently the cornerstone of clinical care of these patients, concerns have been raised following reports of sudden death shortly after growth hormone initiation. This review summarizes the respiratory complications commonly seen and draws together the published literature on the impact of growth hormone in relation to various respiratory parameters, aiming to provide the reader with the necessary information to manage these patients as safely as possible.
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Affiliation(s)
- H-L Tan
- Department of Paediatric Respiratory and Sleep Medicine, Royal Brompton Hospital, London.
| | - D S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh; Department of Child Life and Health, University of Edinburgh
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Abstract
Prader-Willi syndrome (PWS) results from under-expression of the paternally-derived chromosomal region 15q11-13. Growth failure is a recognized feature of PWS, and both quantitative and qualitative defects of the GH/IGF-I axis revealing GH deficiency (GHD) have been demonstrated in most children with PWS. In PWS adults, criteria for GHD are biochemically fulfilled in 8-38% of the studied cohorts. Published data support benefits of early institution of GH therapy (GHT) in PWS children, with positive effects on statural growth, body composition, metabolic homeostasis, and neurocognitive function. Like in pediatric PWS, GHT also yields beneficial effects on lean and body fat, exercise capacity, and quality of life of PWS adults. Although GHT has been generally administered safely in PWS children and adults, careful surveillance of risks is mandatory during prolonged GH replacement for all PWS individuals.
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Affiliation(s)
- Graziano Grugni
- Division of Auxology, I.R.C.C.S. Istituto Auxologico Italiano, Ospedale S. Giuseppe, Verbania, 28921, Italy.
| | - Paolo Marzullo
- Division of General Medicine, I.R.C.C.S. Istituto Auxologico Italiano, Ospedale S. Giuseppe, Verbania, 28921, Italy; Department of Translational Medicine, Università del Piemonte Orientale, Novara, 28100, Italy
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Scheimann AO, Miller J, Glaze DG. Laparoscopic sleeve gastrectomy in children and adolescents with Prader-Willi syndrome: a matched control study. Surg Obes Relat Dis 2016; 13:366. [PMID: 27692916 DOI: 10.1016/j.soard.2016.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/12/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Ann O Scheimann
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jennifer Miller
- Department of Pediatrics, University of Florida School of Medicine, Gainesville, Florida
| | - Daniel G Glaze
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Gillett ES, Perez IA. Disorders of Sleep and Ventilatory Control in Prader-Willi Syndrome. Diseases 2016; 4:diseases4030023. [PMID: 28933403 PMCID: PMC5456282 DOI: 10.3390/diseases4030023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/01/2016] [Accepted: 07/04/2016] [Indexed: 11/16/2022] Open
Abstract
Prader-Willi syndrome (PWS) is an imprinted genetic disorder conferred by loss of paternal gene expression from chromosome 15q11.2-q13. Individuals with PWS have impairments in ventilatory control and are predisposed toward sleep disordered breathing due to a combination of characteristic craniofacial features, obesity, hypotonia, and hypothalamic dysfunction. Children with PWS progress from failure to thrive during infancy to hyperphagia and morbid obesity during later childhood and onward. Similarly, the phenotype of sleep disordered breathing in PWS patients also evolves over time from predominantly central sleep apnea in infants to obstructive sleep apnea (OSA) in older children. Behavioral difficulties are common and may make establishing effective therapy with continuous positive airway pressure (CPAP) more challenging when OSA persists after adenotonsillectomy. Excessive daytime sleepiness (EDS) is also common in patients with PWS and may continue after OSA is effectively treated. We describe here the characteristic ventilatory control deficits, sleep disordered breathing, and excessive daytime sleepiness seen in individuals with PWS. We review respiratory issues that may contribute to sudden death events in PWS patients during sleep and wakefulness. We also discuss therapeutic options for treating sleep disordered breathing including adenotonsillectomy, weight loss, and CPAP. Lastly, we discuss the benefits and safety considerations related to growth hormone therapy.
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Affiliation(s)
- Emily S Gillett
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #83, Los Angeles, CA 90027, USA.
| | - Iris A Perez
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #83, Los Angeles, CA 90027, USA.
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Grugni G, Sartorio A, Crinò A. Growth hormone therapy for Prader-willi syndrome: challenges and solutions. Ther Clin Risk Manag 2016; 12:873-81. [PMID: 27330297 PMCID: PMC4898426 DOI: 10.2147/tcrm.s70068] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Prader-Willi syndrome (PWS) is characterized by a dysregulation of growth hormone (GH)/insulin-like growth factor I axis, as the consequence of a complex hypothalamic involvement. PWS' clinical picture seems to resemble the classic non-PWS GH deficiency (GHD), including short stature, excessive body fat, decreased muscle mass, and impaired quality of life. GH therapy is able to ameliorate the phenotypic appearance of the syndrome, as well as to improve body composition, physical strength, and cognitive level. In this regard, however, some pathophysiologic and clinical questions still remain, representing a challenge to give the most appropriate care to PWS patients. Data about the prevalence of GHD in PWS children are not unequivocal, ranging from 40% to 100%. In this context, to establish whether the presence (or not) of GHD may have a different effect on clinical course during GH therapy may be helpful. In addition, the comparison of GH effects in PWS children diagnosed as small for gestational age with those obtained in subjects born appropriate for gestational age is of potential interest for future trials. Emerging information seems to demonstrate the maintenance of beneficial effects of GH therapy in PWS subjects after adolescent years. Thus, GH retesting after achievement of final height should be taken into consideration for all PWS patients. However, it is noteworthy that GH administration exerts positive effects both in PWS adults with and without GHD. Another critical issue is to clarify whether the genotype-phenotype correlations may be relevant to specific outcome measures related to GH therapy. Moreover, progress of our understanding of the role of GH replacement and concomitant therapies on bone characteristics of PWS is required. Finally, a long-term surveillance of benefits and risks of GH therapy is strongly recommended for PWS population, since most of the current studies are uncontrolled and of short duration.
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Affiliation(s)
- Graziano Grugni
- Division of Auxology, San Giuseppe Hospital, Istituto Auxologico Italiano, Verbania, Italy; Experimental Laboratory for Auxo-endocrinological Research, San Giuseppe Hospital, Istituto Auxologico Italiano, Verbania, Italy
| | - Alessandro Sartorio
- Division of Auxology, San Giuseppe Hospital, Istituto Auxologico Italiano, Verbania, Italy; Experimental Laboratory for Auxo-endocrinological Research, San Giuseppe Hospital, Istituto Auxologico Italiano, Verbania, Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children's Hospital, Rome, Italy
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Pavone M, Caldarelli V, Khirani S, Colella M, Ramirez A, Aubertin G, Crinò A, Brioude F, Gastaud F, Beydon N, Boulé M, Giovannini-Chami L, Cutrera R, Fauroux B. Sleep disordered breathing in patients with Prader-Willi syndrome: A multicenter study. Pediatr Pulmonol 2015; 50:1354-9. [PMID: 25851435 DOI: 10.1002/ppul.23177] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/05/2015] [Accepted: 02/20/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Sleep disordered breathing (SDB) is common in patients with Prader-Willi syndrome (PWS) and systematic screening is recommended, especially before growth hormone treatment. The aim of the study was to describe the baseline SDB and therapeutic interventions in a large cohort of patients. STUDY DESIGN Retrospective study. SUBJECT SELECTION Eighty-eight patients with PWS, median [interquartile range] age of 5.1 [1.0-14.5] years old (range 0.3-44.3), who were followed in three centers (France, Italy). METHODOLOGY Anthropometrics, polygraphy (PG), and gas exchange data were analyzed. RESULTS Median body mass index (BMI) was 20 [16-34] kg/m(2), BMI z-score for patients aged 2-20 years old was 2.1 [1.2-2.8] SD, mixed-obstructive apnea-hypopnea index (MOAHI) 1.8 [0.6-5.0] events/hr, and central apnea index (CAI) 0.1 [0.0-0.6] events/hr. Minimum pulse oximetry (SpO2) was 88 [84-91]%, percentage of time with SpO2 <90% 0.1 [0.0-1.0]%, and oxygen desaturation index 2 [1-4]/hr. An apnea-hypopnea index (AHI) ≥ 1.5 and ≥ 5 events/hr was observed in 53% of children and 41% of adults, respectively. No correlations were observed between MOAHI and anthropometrics data (age, BMI, BMI z-score), while MOAHI significantly correlated with SpO2 indexes. Age and BMI only weakly correlated with SpO2 indexes. Growth hormone could be initiated in 48 patients. Regarding post-PG therapy, 9 patients had upper airway surgery, and noninvasive CPAP/bilevel ventilation was started in 16 patients. CONCLUSIONS Patients with PWS exhibit a high prevalence of SDB. The lack of association between obesity and SDB leads to hypothesize that hypotonia and/or facial dysmorphic features may play a major role in the occurrence of SDB.
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Affiliation(s)
- Martino Pavone
- Respiratory Unit, Bambino Ges, ù, Children's Hospital, Rome, Italy
| | - Valeria Caldarelli
- Respiratory Unit, Bambino Ges, ù, Children's Hospital, Rome, Italy.,Pediatric Unit, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, H, ô, pital Necker, Paris, France.,ASV Santé, Gennevilliers, France
| | | | - Adriana Ramirez
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, H, ô, pital Necker, Paris, France.,ADEP Assistance, Suresnes, France
| | - Guillaume Aubertin
- Pediatric Pulmonary Department, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Antonino Crinò
- Endocrinology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Frédéric Brioude
- Endocrinology Unit, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Frédérique Gastaud
- Endocrinology Unit, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Nicole Beydon
- Lung Function and Sleep Unit, Physiology Department, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Michèle Boulé
- Lung Function and Sleep Unit, Physiology Department, AP-HP, Hôpital Armand Trousseau, Paris, France.,Pierre et Marie Curie University - Paris 6, Paris, France
| | - Lisa Giovannini-Chami
- Pediatric Pulmonary-Allergy Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.,Université de Nice Sophia Antipolis, Nice, France
| | - Renato Cutrera
- Respiratory Unit, Bambino Ges, ù, Children's Hospital, Rome, Italy
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, H, ô, pital Necker, Paris, France.,Paris Descartes University, Paris, France.,INSERM U 955, Equipe 13, Créteil, France
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40
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Beauloye V, Dhondt K, Buysse W, Nyakasane A, Zech F, De Schepper J, Van Aken S, De Waele K, Craen M, Gies I, Francois I, Beckers D, Desloovere A, Francois G, Cools M. Evaluation of the hypothalamic-pituitary-adrenal axis and its relationship with central respiratory dysfunction in children with Prader-Willi syndrome. Orphanet J Rare Dis 2015; 10:106. [PMID: 26329144 PMCID: PMC4557896 DOI: 10.1186/s13023-015-0312-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with Prader-Willi Syndrome (PWS) have been considered at risk for central adrenal insufficiency (CAI). Hypothalamic dysregulation has been proposed as a common mechanism underlying both stress-induced CAI and central respiratory dysfunction during sleep. OBJECTIVE To evaluate CAI and sleep-related breathing disorders in PWS children. PATIENTS AND METHODS Retrospective study of cortisol response following either insulin tolerance test (ITT) or glucagon test (GT) in 20 PWS children, and comparison with 33 non- Growth Hormone deficient (GHD) controls. Correlation between sleep related breathing disorders and cortisol response in 11 PWS children who received both investigations. RESULTS In PWS children, the cortisol peak value showed a significant, inverse correlation with age (Kendall's τ = -0.411; p = 0.012). A similar though non-significant correlation was present between cortisol increase and age (τ = -0.232; p = 0.16). Similar correlations were found in controls. In only 1 of 20 PWS children (5 %), ITT was suggestive of CAI. Four patients had an elevated central apnea index but they all exhibited a normal cortisol response. No relationship was found between peak cortisol or cortisol increase and central apnea index (respectively p = 0.94 and p = 0.14) or the other studied polysomnography (PSG) parameters. CONCLUSIONS CAI assessed by ITT/GT is rare in PWS children. Our data do not support a link between CAI and central respiratory dysregulation.
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Affiliation(s)
- Veronique Beauloye
- Unité d'Endocrinologie pédiatrique, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, avenue Hippocrate 10/1300, Brussels, B-1200, Belgium.
| | - K Dhondt
- Department of Pediatrics, Division of Child Neurology and Metabolism, Pediatric sleep center, Ghent University Hospital, Ghent, Belgium.
| | - W Buysse
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - A Nyakasane
- Unité d'Endocrinologie pédiatrique, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, avenue Hippocrate 10/1300, Brussels, B-1200, Belgium.
| | - F Zech
- IREC, Université Catholique de Louvain, Brussels, Belgium.
| | - J De Schepper
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital and Ghent University, Ghent, Belgium. .,Department of Pediatrics, Division of Ped Endocrinology, UZ Brussel, Brussels, Belgium.
| | - S Van Aken
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - K De Waele
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - M Craen
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - I Gies
- Department of Pediatrics, Division of Ped Endocrinology, UZ Brussel, Brussels, Belgium.
| | - I Francois
- Department of Pediatrics, Division of Ped Endocrinology, KULeuven, Leuven, Belgium.
| | - D Beckers
- Department of Pediatrics, Division of Ped Endocrinology, KULeuven, Leuven, Belgium. .,Department of Pediatrics, Division of Ped Endocrinology, CHU Mont-Godinne-Dinant, Université Catholique de Louvain, Yvoir, Belgium.
| | - A Desloovere
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - G Francois
- Unité de sommeil, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
| | - M Cools
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital and Ghent University, Ghent, Belgium.
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Vogt KS, Emerick JE. Growth Hormone Therapy in Adults with Prader-Willi Syndrome. Diseases 2015; 3:56-67. [PMID: 28943608 PMCID: PMC5548233 DOI: 10.3390/diseases3020056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/05/2015] [Accepted: 04/10/2015] [Indexed: 01/16/2023] Open
Abstract
Prader-Willi syndrome (PWS) is characterized by hyperphagia, obesity if food intake is not strictly controlled, abnormal body composition with decreased lean body mass and increased fat mass, decreased basal metabolic rate, short stature, low muscle tone, cognitive disability, and hypogonadism. In addition to improvements in linear growth, the benefits of growth hormone therapy on body composition and motor function in children with PWS are well established. Evidence is now emerging on the benefits of growth hormone therapy in adults with PWS. This review summarizes the current literature on growth hormone status and the use of growth hormone therapy in adults with PWS. The benefits of growth hormone therapy on body composition, muscle strength, exercise capacity, certain measures of sleep-disordered breathing, metabolic parameters, quality of life, and cognition are covered in detail along with potential adverse effects and guidelines for initiating and monitoring therapy.
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Affiliation(s)
- Karen S Vogt
- Division of Endocrinology, Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, 20889, MD, USA.
| | - Jill E Emerick
- Division of Endocrinology, Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, 20889, MD, USA.
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42
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Lucas-Herald AK, Perry CG, Shaikh MG. Review of growth hormone therapy in adolescents and young adults with Prader-Willi syndrome. Expert Rev Endocrinol Metab 2015; 10:259-267. [PMID: 30293507 DOI: 10.1586/17446651.2015.1007126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Consensus guidelines from the Growth Hormone Research Society Workshop recommend growth hormone therapy in all children with genetically confirmed Prader-Willi syndrome (PWS) in combination with dietary, lifestyle and environmental interventions. As yet, however, there are limited published data regarding the use of growth hormone therapy in adolescents and young adults with PWS. This review focuses on the advantages and disadvantages of growth hormone therapy in this particular group. The risk of complications, challenges with consent for therapy, the need for contraception in females with PWS and the appropriate monitoring required are all factors which must be carefully considered in this challenging patient group. Transition from paediatric to adult services can be difficult for most adolescents, but especially so for PWS adolescents and should be undertaken under the care of experienced paediatric and adult endocrinologists and a multidisciplinary team approach. Further research is, however, still required in the management of PWS patients during adolescence.
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Affiliation(s)
- Angela K Lucas-Herald
- a 1 Developmental Endocrine Research Group, University of Glasgow, RHSC Yorkhill, 3 Dalnair Street, Glasgow, G3 8SJ, UK
| | - Colin G Perry
- b 2 Endocrinology Department, Western General Hospital, Dumbarton Road, Glasgow, G11 6NT, UK
| | - M Guftar Shaikh
- a 1 Developmental Endocrine Research Group, University of Glasgow, RHSC Yorkhill, 3 Dalnair Street, Glasgow, G3 8SJ, UK
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Crockett DJ, Ahmed SR, Sowder DR, Wootten CT, Chinnadurai S, Goudy SL. Velopharyngeal dysfunction in children with Prader-Willi syndrome after adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2014; 78:1731-4. [PMID: 25130946 DOI: 10.1016/j.ijporl.2014.07.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/22/2014] [Accepted: 07/24/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Prader-Willi syndrome (PWS) is a rare genetic disorder with an incidence rate of 1 in 10,000-30,000. Patients with PWS typically have symptoms related to hypotonia, obesity, and hypothalamic dysfunction. A high rate of obstructive sleep apnea (OSA) is found among this population of patients. Adenotonsillectomy has been advocated as a first line approach for treatment of OSA in patients with PWS. Velopharyngeal dysfunction (VPD) is a known complication of adenotonsillectomy. VPD can also be present in patients with global hypotonia, such as those with PWS. The objective of this study is to review the occurrence of VPD in patients with PWS after adenotonsillectomy for OSA. METHODS A retrospective review was performed of all patients with PWS and OSA from a tertiary pediatric hospital between the years of 2002 and 2012. Pre- and post-operative sleep studies and sleep disordered breathing symptoms, post-operative VPD assessment by the speech-language pathologist (SLP), and VPD treatments were evaluated. RESULTS Eleven patients (five males and six females), fitting the inclusion criteria, were identified. The age of the patient at the initial otolaryngologic evaluation ranged from 2 to 9 years. All patients underwent adenotonsillectomy for sleep disordered breathing. Four patients were diagnosed with post-operative hypernasality after assessment by a speech-language pathologist. The hypernasality ranged from mild to moderately severe. Of the four patients with hypernasality, two were found to have structural issues requiring surgery (pharyngeal flap). Both of the surgical patients experienced significant improvement in their VPD after surgery. The remaining two patients were found to have articulation error patterns that were considered more developmental in nature and both responded to speech therapy. All patients, except one, had improvement in their polysomnogram or sleep symptoms after adenotonsillectomy. However, three patients continue to require continuous positive airway pressure at night. CONCLUSION Velopharyngeal dysfunction may occur after adenotonsillectomy in patients with Prader-Willi Syndrome. Families should be counseled of this risk and the potential need for operative intervention to correct it.
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Affiliation(s)
- David J Crockett
- Vanderbilt University Medical Center, Department of Otolaryngology, 7209 Medical Center-East-South Tower, 1215 21st Avenue South, Nashville, TN, 37232, USA.
| | - Saqib R Ahmed
- Marshall University Medical Center, School of Medicine, 1600 Medical Center Drive, Huntington, WV, 25701, USA.
| | - Derrick R Sowder
- Vanderbilt University Medical Center, Hearing and Speech, 7209 Medical Center-East-South Tower, 1215 21st Avenue South, Nashville, TN, 37232, USA.
| | - Christopher T Wootten
- Vanderbilt University Medical Center, Department of Otolaryngology, 7209 Medical Center-East-South Tower, 1215 21st Avenue South, Nashville, TN, 37232, USA.
| | - Sivakumar Chinnadurai
- Vanderbilt University Medical Center, Department of Otolaryngology, 7209 Medical Center-East-South Tower, 1215 21st Avenue South, Nashville, TN, 37232, USA.
| | - Steven L Goudy
- Vanderbilt University Medical Center, Department of Otolaryngology, 7209 Medical Center-East-South Tower, 1215 21st Avenue South, Nashville, TN, 37232, USA.
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44
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Sedky K, Bennett DS, Pumariega A. Prader Willi syndrome and obstructive sleep apnea: co-occurrence in the pediatric population. J Clin Sleep Med 2014; 10:403-9. [PMID: 24733986 PMCID: PMC3960383 DOI: 10.5664/jcsm.3616] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A high prevalence of obstructive sleep apnea (OSA) occurs in children with Prader-Willi syndrome (PWS). Yet, due in part to the relatively small samples previously used, the prevalence of OSA has varied greatly across studies. It is also unclear if factors such as age, gender, body mass index (BMI), or type of genetic imprinting are associated with increased risk for OSA among children with PWS. OBJECTIVES To evaluate the (a) prevalence of OSA, as well as narcolepsy, in pediatric populations diagnosed with PWS; (b) effects of age, gender, body mass index, and genetic imprinting on OSA severity; and (c) efficacy of adenotonsillectomy (AT) for decreasing OSA severity in this population. METHODS All studies assessing OSA among children with PWS through August 2013 were identified using the PubMed/Medline, Psych Info, Cochrane library, and Google Scholar data bases. RESULTS Fourteen studies of children diagnosed with PWS and who were assessed for OSA using polysomnography (PSG) met inclusion criteria (n = 224 children). The prevalence of OSA across studies was 79.91% (n = 179/224). Among youths with OSA, 53.07% had mild OSA, 22.35% moderate OSA, and 24.58% severe OSA. Narcolepsy was found to occur in 35.71% of children with PWS. Adenotonsillectomy was associated with improvement in OSA for most children with PWS. However, residual OSA was present in the majority of cases post-surgery. CONCLUSION This study confirms the high prevalence of OSA and narcolepsy among children with PWS. Screening for OSA and narcolepsy among children with PWS is recommended. In addition, while adenotonsillectomy was effective in reducing OSA for some children, alternative treatments may need to be considered, given the only moderate response rate.
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Affiliation(s)
- Karim Sedky
- Department of Psychiatry, Cooper University Hospital, Camden, NJ
| | - David S. Bennett
- Department of Psychiatry, Drexel University College of Medicine, Philadelphia, PA
| | - Andres Pumariega
- Department of Psychiatry, Cooper University Hospital, Camden, NJ
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45
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Gallego J. Genetic diseases: congenital central hypoventilation, Rett, and Prader-Willi syndromes. Compr Physiol 2013; 2:2255-79. [PMID: 23723037 DOI: 10.1002/cphy.c100037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The present review summarizes current knowledge on three rare genetic disorders of respiratory control, congenital central hypoventilation syndrome (CCHS), Rett syndrome (RTT), and Prader-Willi syndrome (PWS). CCHS is characterized by lack of ventilatory chemosensitivity caused by PHOX2B gene abnormalities consisting mainly of alanine expansions. RTT is associated with episodes of tachypneic and irregular breathing intermixed with breathholds and apneas and is caused by mutations in the X-linked MECP2 gene encoding methyl-CpG-binding protein. PWS manifests as sleep-disordered breathing with apneas and episodes of hypoventilation and is caused by the loss of a group of paternally inherited genes on chromosome 15. CCHS is the most specific disorder of respiratory control, whereas the breathing disorders in RTT and PWS are components of a more general developmental disorder. The main clinical features of these three disorders are reviewed with special emphasis on the associated brain abnormalities. In all three syndromes, disease-causing genetic defects have been identified, allowing the development of genetically engineered mouse models. New directions for future therapies based on these models or, in some cases, on clinical experience are delineated. Studies of CCHS, RTT, and PWS extend our knowledge of the molecular and cellular aspects of respiratory rhythm generation and suggest possible pharmacological approaches to respiratory control disorders. This knowledge is relevant for the clinical management of many respiratory disorders that are far more prevalent than the rare diseases discussed here.
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Affiliation(s)
- Jorge Gallego
- Inserm U676 and University of Paris Diderot, Paris, France.
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47
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Abstract
Prader-Willi Syndrome is a complex neurogenetic disorder characterized by appetite dysregulation, obesity with decreased muscle mass and increased fat mass, behavioral problems, various endocrinopathies, and sleep and respiratory abnormalities. Respiratory issues include both central and obstructive sleep apnea, excessive daytime sleepiness, narcolepsy, and impaired ventilatory control. There is some controversy as to whether growth hormone treatment, which is the standard of care for patients with Prader-Willi Syndrome, exacerbates or ameliorates the sleep-disordered breathing issues associated with this syndrome. The natural history of sleep and breathing issues and the issues surrounding growth hormone treatment on sleep-disordered breathing are discussed.
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48
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Emerick JE, Vogt KS. Endocrine manifestations and management of Prader-Willi syndrome. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2013; 2013:14. [PMID: 23962041 PMCID: PMC3751775 DOI: 10.1186/1687-9856-2013-14] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 01/05/2023]
Abstract
Prader-Willi syndrome (PWS) is a complex genetic disorder, caused by lack of expression of genes on the paternally inherited chromosome 15q11.2-q13. In infancy it is characterized by hypotonia with poor suck resulting in failure to thrive. As the child ages, other manifestations such as developmental delay, cognitive disability, and behavior problems become evident. Hypothalamic dysfunction has been implicated in many manifestations of this syndrome including hyperphagia, temperature instability, high pain threshold, sleep disordered breathing, and multiple endocrine abnormalities. These include growth hormone deficiency, central adrenal insufficiency, hypogonadism, hypothyroidism, and complications of obesity such as type 2 diabetes mellitus. This review summarizes the recent literature investigating optimal screening and treatment of endocrine abnormalities associated with PWS, and provides an update on nutrition and food-related behavioral intervention. The standard of care regarding growth hormone therapy and surveillance for potential side effects, the potential for central adrenal insufficiency, evaluation for and treatment of hypogonadism in males and females, and the prevalence and screening recommendations for hypothyroidism and diabetes are covered in detail. PWS is a genetic syndrome in which early diagnosis and careful attention to detail regarding all the potential endocrine and behavioral manifestations can lead to a significant improvement in health and developmental outcomes. Thus, the important role of the provider caring for the child with PWS cannot be overstated.
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Affiliation(s)
- Jill E Emerick
- Department of Pediatrics, Walter Reed National Military Medical Center Bethesda, 8901 Wisconsin Ave, Bethesda, MD 20889, USA.
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Deal CL, Tony M, Höybye C, Allen DB, Tauber M, Christiansen JS. GrowthHormone Research Society workshop summary: consensus guidelines for recombinant human growth hormone therapy in Prader-Willi syndrome. J Clin Endocrinol Metab 2013; 98:E1072-87. [PMID: 23543664 PMCID: PMC3789886 DOI: 10.1210/jc.2012-3888] [Citation(s) in RCA: 228] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
CONTEXT Recombinant human GH (rhGH) therapy in Prader-Willi syndrome (PWS) has been used by the medical community and advocated by parental support groups since its approval in the United States in 2000 and in Europe in 2001. Its use in PWS represents a unique therapeutic challenge that includes treating individuals with cognitive disability, varied therapeutic goals that are not focused exclusively on increased height, and concerns about potential life-threatening adverse events. OBJECTIVE The aim of the study was to formulate recommendations for the use of rhGH in children and adult patients with PWS. EVIDENCE We performed a systematic review of the clinical evidence in the pediatric population, including randomized controlled trials, comparative observational studies, and long-term studies (>3.5 y). Adult studies included randomized controlled trials of rhGH treatment for ≥ 6 months and uncontrolled trials. Safety data were obtained from case reports, clinical trials, and pharmaceutical registries. METHODOLOGY Forty-three international experts and stakeholders followed clinical practice guideline development recommendations outlined by the AGREE Collaboration (www.agreetrust.org). Evidence was synthesized and graded using a comprehensive multicriteria methodology (EVIDEM) (http://bit.ly.PWGHIN). CONCLUSIONS Following a multidisciplinary evaluation, preferably by experts, rhGH treatment should be considered for patients with genetically confirmed PWS in conjunction with dietary, environmental, and lifestyle interventions. Cognitive impairment should not be a barrier to treatment, and informed consent/assent should include benefit/risk information. Exclusion criteria should include severe obesity, uncontrolled diabetes mellitus, untreated severe obstructive sleep apnea, active cancer, or psychosis. Clinical outcome priorities should vary depending upon age and the presence of physical, mental, and social disability, and treatment should be continued for as long as demonstrated benefits outweigh the risks.
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Affiliation(s)
- Cheri L Deal
- Research Center and Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada H3T 1C5.
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Hartman ML, Xu R, Crowe BJ, Robison LL, Erfurth EM, Kleinberg DL, Zimmermann AG, Woodmansee WW, Cutler GB, Chipman JJ, Melmed S. Prospective safety surveillance of GH-deficient adults: comparison of GH-treated vs untreated patients. J Clin Endocrinol Metab 2013; 98:980-8. [PMID: 23345098 PMCID: PMC3677286 DOI: 10.1210/jc.2012-2684] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In clinical practice, the safety profile of GH replacement therapy for GH-deficient adults compared with no replacement therapy is unknown. OBJECTIVE The objective of this study was to compare adverse events (AEs) in GH-deficient adults who were GH-treated with those in GH-deficient adults who did not receive GH replacement. DESIGN AND SETTING This was a prospective observational study in the setting of US clinical practices. PATIENTS AND OUTCOME MEASURES AEs were compared between GH-treated (n = 1988) and untreated (n = 442) GH-deficient adults after adjusting for baseline group differences and controlling the false discovery rate. The standardized mortality ratio was calculated using US mortality rates. RESULTS After a mean follow-up of 2.3 years, there was no significant difference in rates of death, cancer, intracranial tumor growth or recurrence, diabetes, or cardiovascular events in GH-treated compared with untreated patients. The standardized mortality ratio was not increased in either group. Unexpected AEs (GH-treated vs untreated, P ≤ .05) included insomnia (6.4% vs 2.7%), dyspnea (4.2% vs 2.0%), anxiety (3.4% vs 0.9%), sleep apnea (3.3% vs 0.9%), and decreased libido (2.1% vs 0.2%). Some of these AEs were related to baseline risk factors (including obesity and cardiopulmonary disease), higher GH dose, or concomitant GH side effects. CONCLUSIONS In GH-deficient adults, there was no evidence for a GH treatment effect on death, cancer, intracranial tumor recurrence, diabetes, or cardiovascular events, although the follow-up period was of insufficient duration to be conclusive for these long-term events. The identification of unexpected GH-related AEs reinforces the fact that patient selection and GH dose titration are important to ensure safety of adult GH replacement.
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Affiliation(s)
- Mark L Hartman
- Lilly Research Laboratories, Indianapolis, Indiana 46285, USA
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