Morkous Ss1,2,3. 1. Department of Pediatrics, Pediatric Neurology Division, Lehigh Valley Children's Hospital, Allentown, PA, USA. 2. Pediatrics Core Academic Rank, Morsani College of Medicine, University of South Florida, Tampa, FL, USA. 3. Department of Clinical Sciences, DeSales University, Center Valley, PA, USA.
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.
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.
Authors: J M Gerard; L Garibaldi; S E Myers; T Aceto; S Kotagal; V P Gibbons; J Stith; C Weber Journal: Clin Pediatr (Phila) Date: 1997-06 Impact factor: 1.168
Authors: Merrill S Wise; Cynthia D Nichols; Madeleine M Grigg-Damberger; Carole L Marcus; Manisha B Witmans; Valerie G Kirk; Lynn A D'Andrea; Timothy F Hoban Journal: Sleep Date: 2011-03-01 Impact factor: 5.849