Sleep-Disordered Breathing in Children with Achondroplasia: 17 Years' Experience from a Multidisciplinary Team

Abstract The aim of this study was to describe sleep-disordered breathing (SDB) and treatment in children with achondroplasia (ACH). A retrospective longitudinal study was conducted at the Sleep Unit, Hospital de Pediatría Garrahan. Children with ACH, aged 0 to 18 years, referred for SDB due to clinical symptoms or foramen magnum stenosis (FMS) with at least one polysomnography (PSG) between 2002 and 2019 were included in the study. The primary outcomes included SDB typification and therapeutic interventions. We included 89 patients; 79.7% had one PSG, 13.4% had two PSGs, and 5.6% had three PSGs. The first PSG confirmed SDB in 65.16% patients. Obstructive sleep apnea (OSA) was present in 59.6% patients, central sleep apnea (CSA) in 1.72% patients, OSA + CSA in 4.49% patients, and normal PSG in 34.83% patients. OSA was mild in 32.07% patients, moderate in 18.86% patients, and severe in 49.05% patients. Clinical and airway evaluation, central imaging, evoked potentials, and PSG were considered before each therapeutic decision. After the first PSG, patients received one or more treatments as needed: watchful waiting; nasal steroids; ear, nose, and throat surgery; foramen magnum decompression; and noninvasive ventilation. A second PSG was available in 18 patients and 72.22% had SDB. A third PSG was available in 10 patients and 77.8% had SDB. We reconfirm an elevated frequency of SDB in ACH children and underline the need for a multidisciplinary and stepwise longitudinal approach.