Sleep Disordered Breathing in Special Populations

SDB may occur more often in special populations (82-86). Any condition or syndrome associated with craniofacial anomalies may be associated with SDB. Pierre Robin (Fig. 2), Apert's and Crouzon's are among these syndromes. Approximately

FIGURE 2 (See color insert.) Infant with Pierre Robin syndrome; micrognathia, specifically mandibular hypoplasia, as depicted is characteristic of this disorder.

FIGURE 2 (See color insert.) Infant with Pierre Robin syndrome; micrognathia, specifically mandibular hypoplasia, as depicted is characteristic of this disorder.

half of all children with Down syndrome have SDB. However, symptoms of daytime sleepiness and sleep disruptions at night may be due to non-neurological factors such as maxillofacial abnormalities, large tonsils or adenoids, micrognathia, large tongues, or other abnormalities. Sleep disorders often occur in patients with neuromuscular disease because of associated weakness in respiratory muscles, which is further exacerbated by hypotonia during sleep. In disorders such as Duchenne's muscular dystrophy, daytime pulmonary function studies do not predict the degree of apneic events during sleep. Rather, these patients can have nocturnal oxygen desaturation, significant sleep fragmentation, recurrent hypoventilation, and reduced REM sleep. These patients are also at increased risk for aspiration during sleep. Diagnosis and treatment of SDB in these patients can be an important part of comprehensive management.

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