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Obstructive events in children with Prader-Willi syndrome occur predominantly during rapid eye movement sleep

Anastasia Polytarchou1, Georgia Katsouli1, Marina Tsaoussoglou1

  • 1Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece.

Sleep Medicine
|December 12, 2018
PubMed

Insights

Children with Prader-Willi syndrome (PWS) experience significantly more obstructive sleep apnea events during REM sleep than non-PWS children. This highlights the need for tailored sleep apnea assessments in PWS patients.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Genetics

Background:

  • Prader-Willi syndrome (PWS) is associated with a high incidence of obstructive sleep apnea syndrome (OSAS).
  • Typically developing children with OSAS exhibit more obstructive events during REM sleep than NREM sleep.
  • It is hypothesized that PWS patients have a greater propensity for REM sleep-related obstructive events.

Purpose of the Study:

  • To compare the severity of obstructive sleep apnea (OSAS) during REM sleep between children with PWS and typically developing children.
  • To investigate if PWS diagnosis is independently associated with increased REM sleep obstructive events.

Main Methods:

  • Polysomnographic data from 12 children with PWS and 53 controls with OSAS were analyzed.
  • Obstructive apnea-hypopnea index (OAHI) during NREM (OAHInrem) and REM (OAHIrem) sleep, and the OAHIrem/OAHI ratio were compared.
  • A general linear model was used to adjust for confounders like age, gender, and obesity.

Main Results:

  • Children with PWS and controls had similar overall OAHI and OAHInrem.
  • PWS patients exhibited significantly higher OAHIrem (17.6 vs. 5 episodes/h) and OAHIrem/OAHI ratio (2.3 vs. 1) compared to controls.
  • The association between PWS and increased OAHIrem/OAHI remained significant after adjusting for confounders.

Conclusions:

  • In children with PWS, total sleep time OAHI underestimates OSAS severity during REM sleep.
  • OSAS severity during REM sleep in PWS patients can be substantially higher, potentially twice that of controls.
  • Mild OSAS detected without sleep staging in PWS may indicate moderate-to-severe REM sleep-related events.
Abstract

Keywords:
Obstructive sleep apnea syndromePrader–Willi syndromeREM sleepSleep hypopnea

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