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Upper airway obstructive disease in mucopolysaccharidoses: Polysomnography, computed tomography and nasal endoscopy findings

  • Original Article
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Journal of Inherited Metabolic Disease

Summary

In mucopolysaccharidoses, upper airway obstruction has multiple causative factors and progressive respiratory disease may severely affect morbidity and mortality. In a cross-sectional study over 2 years we evaluated upper airway obstructive disease through overnight polysomnography, upper airway computed tomography and nasal endoscopy in 5 children and 6 adults with mucopolysaccharidoses of various types. Measurements of apnoea and apnoea-hypopnoea index, arousal index, and sleep efficiency were obtained through polysomnography. Retropalatal and retroglossal spaces were calculated through computed tomography, and the degree of adenoid hypertrophy was assessed through endoscopy. Apnoea index and apnoea-hypopnoea index were significantly higher in children than in adults with mucopolysaccharidoses (p=.03 and p=03, respectively). Compared to healthy controls, retropalatal and retroglossal spaces were significantly smaller in children (p=03 and p=.004, respectively) or adults with mucopolysaccharidoses (p=.004 and p=.004, respectively). All subjects had adenoid hypertrophy causing first-degree (36%) or second-degree (64%) obstruction at endoscopy. Overnight polysomnography, upper airway computed tomography and nasal endoscopy are useful tools for diagnosing obstructive sleep apnoea syndrome in mucopolysaccharidoses, and identifying the site and severity of airway obstruction.

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References

  • Allen JL (2004) Treatment of respiratory system (not just lung!) abnormalities in mucopolysaccharidosis I. J Pediatr 144: 561–562.

    Article  PubMed  Google Scholar 

  • American Thoracic Society (1996) Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 153: 866–878.

    Google Scholar 

  • Arens R, McDonough JM, Corbin AM, et al (2003) Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 167: 65–70.

    Article  PubMed  Google Scholar 

  • Brenner DJ (2002) Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32: 228–233.

    Article  PubMed  Google Scholar 

  • Caballero P, Alvarez-Sala R, Garcia-Rio F, et al (1998) CT in the evaluation of the upper airway in healthy subjects and in patients with obstructive sleep apnea syndrome. Chest 113: 111–116.

    Article  CAS  PubMed  Google Scholar 

  • Cassano P, Gelardi M, Cassano M, Fiorella ML, Fiorella R (2003) Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic management. Int J Pediatr Otorhinolaryngol 67: 1303–1309.

    Article  PubMed  Google Scholar 

  • Fregosi RF, Quan SF, Kaemingk KL, et al (2003) Sleep-disordered breathing, pharyngeal size and soft tissue anatomy in children. J Appl Physiol 95: 2030–2038.

    CAS  PubMed  Google Scholar 

  • Guilleminault C, Van den Hoed J, Mitler M (1978) Clinical overview of the sleep apnea syndromes. In: Guilleminault C, Dement W, eds. Sleep Apnea Syndrome. New York: Alan R. Liss, 1–2.

    Google Scholar 

  • Hamans EP, Van Marck EA, De Backer WA, Creten W, Van de Heyning PH (2000) Morphometric analysis of the uvula in patients with sleep-related breathing disorders. Eur Arch Otorhinolaryngol 257: 232–236.

    Article  CAS  PubMed  Google Scholar 

  • Harmatz P, Giugliani R, Schwartz I, et al (2006) MPS VI Phase 3 Study Group. Enzyme replacement therapy for mucopolysaccharidosis VI: a phase 3, randomized, double-blind, placebo-controlled, multinational study of recombinant human N-acetylgalactosamine 4-sulfatase (recombinant human arylsulfatase B or rhASB) and follow-on, open-label extension study. J Pediatr 148: 533–539.

    Article  CAS  PubMed  Google Scholar 

  • Kakkis ED, Muenzer J, Tiller GE, et al (2001) Enzyme-replacement therapy in mucopolysaccharidosis I. N Engl J Med 344: 182–188.

    Article  CAS  PubMed  Google Scholar 

  • Kurihara M, Kumagai K, Goto K, Imai M, Yagishita S (1992) Severe type Hunter’s syndrome. Polysomnographic and neuropathological study. Neuropediatrics 23: 248–256.

    Article  CAS  PubMed  Google Scholar 

  • Leighton SE, Papsin B, Vellodi A, et al (2001) Disordered breathing during sleep in patients with mucopolysaccharidoses. Int J Pediatr Otorhinolaryngol 58: 127–138.

    Article  CAS  PubMed  Google Scholar 

  • Li HY, Chen NH, Wang CR, Shu YH, Wang PC (2003) Use of 3-dimensional computed tomography scan to evaluate upper airway patency for patients undergoing sleep-disordered breathing surgery. Otolaryngol Head Neck Surg 129: 336–342.

    Article  PubMed  Google Scholar 

  • Li HY, Li KK, Chen NH, et al (2005) Three-dimensional computed tomography and polysomnography findings after extended uvulopalatal flap surgery for obstructive sleep apnea. Am J Otolaryngol 26: 7–11.

    Article  CAS  PubMed  Google Scholar 

  • Marcus CL (2000) Obstructive sleep apnea syndrome: differences between children and adults. Sleep 23: S140–141.

    PubMed  Google Scholar 

  • Muenzer J (2004) The mucopolysaccharidoses: a heterogeneous group of disorders with variable pediatric presentations. J Pediatr 144: S27–34.

    Article  CAS  PubMed  Google Scholar 

  • Muenzer J, Wraith JE, Beck M, et al (2006) A phase II/III clinical study of enzyme replacement therapy with idursulfatase in mucopolysaccharidosis II (Hunter syndrome). Genet Med 8: 465–473.

    Article  CAS  PubMed  Google Scholar 

  • Neufeld EF, Muenzer J (2001) The mucoplysaccharidoses. In: Scriver CR, Beaudet AL, Sly WS, Valle D, eds; Childs B, Kinzler KW, Vogelstein B, assoc, eds. The Metabolic and Molecular Bases of Inherited Disease, 8th edn. New York: McGraw-Hill, 3421–3452.

    Google Scholar 

  • Orliaguet O, Pepin JL, Veale D, Kelkel E, Pinel N, Levy P (1999) Hunter’s syndrome and associated sleep apnoea cured by CPAP and surgery. Eur Respir J 13: 1195–1197.

    Article  CAS  PubMed  Google Scholar 

  • Perks WH, Cooper RA, Bradbury S, et al (1980) Sleep apnoea in Scheie’s syndrome. Thorax 35: 85–91.

    Article  CAS  PubMed  Google Scholar 

  • Pien HH, Fischman AJ, Thrall JH, Sorensen AG (2005) Using imaging biomarkers to accelerate drug development and clinical trials. Drug Discov Today 10: 259–266.

    Article  CAS  PubMed  Google Scholar 

  • Rama AN, Tekwani SH, Kushida CA (2002) Sites of obstruction in obstructive sleep apnea. Chest 122: 1139–1147.

    Article  PubMed  Google Scholar 

  • Rechtschaffen A, Kales A (1968) A Manual of Standardized Terminology, Techniques and Scoring Systems for Sleep Stages on Human Subjects. Los Angeles, CA: Brain Information Service/Brain Research Institute, University of California, Los Angeles, 15–24.

    Google Scholar 

  • Semenza GL, Pyeritz RE (1988) Respiratory complications of mucopolysaccharide storage disorders. Medicine 67: 209–219.

    Article  CAS  PubMed  Google Scholar 

  • Shapiro J, Strome M, Crocker AC (1985) Airway obstruction and sleep apnea in Hurler and Hunter syndromes. Ann Otol Rhinol Laryngol 94: 458–461.

    CAS  PubMed  Google Scholar 

  • Shepard JW Jr, Thawley SE (1989) Evaluation of the upper airway by computerized tomography in patients undergoing uvulopalatopharyngoplasty for obstructive sleep apnea. Am Rev Respir Dis 140: 711–716.

    PubMed  Google Scholar 

  • Simmons MA, Bruce IA, Penney S, Wraith E, Rothera MP (2005) Otorhinolaryngological manifestations of the mucopolysaccharidoses. Int J Pediatr Otorhinolaryngol 69: 589–595.

    Article  CAS  PubMed  Google Scholar 

  • Sleep Medicine Task Force (1999) Sleep-related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22: 667–689.

    Google Scholar 

  • Sleep Disorders Association (1992) EEG arousal: scoring rules and examples. Sleep 15: 174–184.

    Google Scholar 

  • Walker PP, Rose E, Williams JG (2003) Upper airways abnormalities and tracheal problems in Morquio’s disease. Thorax 58: 458–459.

    Article  CAS  PubMed  Google Scholar 

  • Wang DY, Bernheim N, Kaufman L, Clement P (1997) Assessment of adenoid size in children by fibreoptic examination. Clin Otolaryngol Allied Sci 22: 172–177.

    Article  CAS  PubMed  Google Scholar 

  • Witmans MB, Keens TG, Davidson Ward SL, Marcus CL (2003) Obstructive hypopneas in children and adolescents: normal values. Am J Respir Crit Care Med 168: 1540.

    PubMed  Google Scholar 

  • Wraith JE (2005) The first 5 years of clinical experience with laronidase enzyme replacement therapy for mucopolysaccharidosis I. Expert Opin Pharmacother 6: 489–506.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to G. Andria.

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Communicating editor: Ed Wraith

Competing interests: None declared

References to electronic databases: Mucopolysaccharidoses: OMIM #252700.

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Santamaria, F., Andreucci, M.V., Parenti, G. et al. Upper airway obstructive disease in mucopolysaccharidoses: Polysomnography, computed tomography and nasal endoscopy findings. J Inherit Metab Dis 30, 743–749 (2007). https://doi.org/10.1007/s10545-007-0555-5

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  • DOI: https://doi.org/10.1007/s10545-007-0555-5

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