Human Genetics

, Volume 73, Issue 1, pp 39–43 | Cite as

Familial lethal sleep apnea

  • F. D. Adickes
  • B. A. Buehler
  • W. G. Sanger
Original Investigations

Summary

Three of six siblings presented with sleep apnea between 18 and 26 months of age. Twin females and a male had normal growth and development without antecedent neurologic or apparent metabolic disorder. The females presented at 25 and 27 months respectively with irregular respiration and episodes of apnea. Twin A succumbed to an apneic episode while sleeping. Central sleep apnea was diagnosed in twin B at the Stanford Sleep Clinic. She died following an apneic episode three months after evaluation. The male presented at 18 months with fatal sleep apnea. A fourth child was evaluated for sleep apnea at 7 weeks of age with several hospitalizations before her death at 31 months. She and remaining family members were extensively studied for inherited neurologic disorders including subacute necrotizing encephalomyopathy (SANE, Leigh disease). This family with lethal sleep apnea presents an association with SANE with minimal neurologic signs and symptoms and neuropathologic involvement. Lesions were conined to the respiratory centers of the lower brain stem, making sleep apnea explicable. This child and family members tested positive or borderline for inhibitor substance thiamine triphosphate (TTP). All testing for TTP inhibitor substance was performed in Professor Jack R. Cooper's laboratory, Department of Pharmacology, Yale University School of Medicine, New Haven, Conn. These cases present an interesting and instructive lesson emphasizing the need for extensive evaluation of children with unsuspected sleep apnea with early demise.

Keywords

Sleep Apnea Thiamine Inhibitor Substance Neurologic Disorder Central Sleep Apnea 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Baba N, Quattrochi JJ, Reiner CB, Adrion W, McBride PT, Yates AJ (1983) Possible role of the brain stem in sudden infant death syndrome. JAMA 249:2789–2791Google Scholar
  2. Benke PJ, Parker JC, Lubs ML, Benkendorf J, Feuer AE (1982) X-linked Leigh's syndrome. Hum Genet 62:52–59Google Scholar
  3. Brahms M, Collins GH, Crosley CJ (1979) Rapidly fatal subacute necrotizing encephalomyelopathy (Leigh's syndrome) in a five-year-old boy. Clin Pediatr (Phila) 8:506–508Google Scholar
  4. Brodall A (1957) The reticular formation of the brain stem. Anatomic aspects and functional considerations. Thomas, Springfield, Ill, pp 1–87Google Scholar
  5. Clayton BE, Dobbs RH, Patrick AD (1967) Leigh's subacute necrotizing encephalopathy: clinical and biochemical study with special reference to therapy with lipoate. Arch Dis Child 42:467–478Google Scholar
  6. Cooper JR, Itokawa Y, Pincus JH (1969) Thiamine triphosphate deficiency in subacute necrotizing encephalopathy. Science 164:74–75Google Scholar
  7. Cooper JR, Pincus JH, Itokawa Y, Piros K (1970) Experience with phosphoryl transferase inhibition in subacute necrotizing encephalopathy. N Engl J Med 283:793–795Google Scholar
  8. Eisengart MA, Powers JM, Rose AL (1974) Subacute necrotizing encephalomyelopathy. (Rapidly fatal course in Leigh's disease in a 5-year-old child). Am J Dis Child 127:730–732Google Scholar
  9. Fergin I, Kim HS (1977) Subacute necrotizing encephalomyelopathy in a neonatal infant. J Neuropathol Exp Neurol 36:364–372Google Scholar
  10. Greenhouse AH, Schneck SA (1968) Subacute necrotizing encephalopathy: a reappraisal of the thiamine deficiency hypothesis. Neurology (NY) 18:1–8Google Scholar
  11. Greenwood RS, De Vivo DC, Nelson JS, Dodson WE, Raiche ME, Gado M, Haymond MW, Prensky AL (1975) An autosomal dominant form of necrotizing encephalomyelopathy resembling a spinocerebellar degeneration. Trans Am Neurol Assoc 100:47–51Google Scholar
  12. Guggenheim MA, Stumpf DA (1977) Familial metabolic disease with clinicopathological findings of both Leigh's disease and the adulttype spinocerebellar degeneration. Ann Neurol 2:264–265Google Scholar
  13. Johnson FH, Russell GV (1952) The locus ceruleus as a pneumotactic center. Anat Rec 112:348Google Scholar
  14. Kissach AW, Currie S, Harriman DGF, Littlewood JM, Payne RB, Walker BE (1974) Leigh's disease and failure of autonomic respiration. Lancet II:662Google Scholar
  15. Leigh D (1951) Subacute necrotizing encephalomyelopathy in an infant. J Neurol Neurosurg Psychiatry 14:216–221Google Scholar
  16. Montpetit VJA, Andermann F, Carpenter S, Fawcett JS, Zborowska-Sluis D, Giberson HR (1971) Subacute necrotizing encephalomyelopathy: a review and study of two families. Brain 94:1–30Google Scholar
  17. Ngai SH, Wang SC (1957) Organization of central respiratory mechanisms in the brain stem of the cat: localization by stimulation and destruction. Am J Physiol 190:343–349Google Scholar
  18. Peterson HD, Alvord EC (1964) Necrotizing encephalopathy with preleliction for the brain stem. Trans Am Neurol Assoc 89:104–107Google Scholar
  19. Pincus JH (1972) Subacute necrotizing encephalopathy (Leigh disease): a consideration of clinical features and etiology. Dev Med Child Neurol 14:87–101Google Scholar
  20. Pitts RF (1940) The respiratory center and its descending pathways. J Comp Neurol 72:605–625Google Scholar
  21. Plaitakis A, Whetsell WO, Cooper JR, Yahr MD (1980) Chronic Leigh disease: a genetic and biochemical study. Ann Neurol 7:304–310Google Scholar
  22. Torvik A, Brodall A (1957) The origin of reticulospinal fibers in the cat, an experimental study. Anat Rec 128:113–137Google Scholar
  23. Worsley HE, Brookfield RW, Elwood JS, Noble RL, Taylor WH (1965) Lactic acidosis with necrotizing encephalopathy in two sibs. Arch Dis Child 40:492–501Google Scholar
  24. Yashon D, Jane JA (1967) Subacute necrotizing encephalomyclopathy of infancy and childhood. J Clin Patho 20:28–37Google Scholar

Copyright information

© Springer-Verlag 1986

Authors and Affiliations

  • F. D. Adickes
    • 1
  • B. A. Buehler
    • 1
  • W. G. Sanger
  1. 1.Department of Pathology and Microbiology, Pediatrics, Hattie B. Munroe Center for Human Genetics and Meyer's Children Rehabilitation InstituteUniversity of Nebraska Medical CenterOmahaUSA

Personalised recommendations