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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: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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