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Original Research: Sleep Disorders |

Sleep-Disordered Breathing in Ehlers-Danlos SyndromeSleep-Disorder Breathing and Ehlers Danlos: A Genetic Model of OSA

Christian Guilleminault, DM, MD, DBiol; Michelle Primeau, MD; Hsiao-yean Chiu, RN, MS; Kin Min Yuen, MD; Damien Leger, DM, DBiol; Arnaud Metlaine, DM
Author and Funding Information

From the Sleep Medicine Division (Drs Guilleminault, Primeau, and Yuen and Ms Chiu), Stanford University, Stanford Outpatient Medical Center, Redwood City, CA; and Centre de la vigilance (Drs Leger and Metlaine), Hopital de L’Hôtel-Dieu, Universite Paris-Descartes, Paris, France.

Correspondence to: Christian Guilleminault, DM, MD, DBiol, Sleep Medicine Division, Stanford University, Stanford Outpatient Medical Center, 450 Broadway, Redwood City, CA 94063; e-mail: cguil@stanford.edu


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(5):1503-1511. doi:10.1378/chest.13-0174
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Objectives:  The objective of this study was to investigate the presence of sleep-disordered breathing (SDB) in patients with Ehlers-Danlos syndrome. Ehlers-Danlos syndrome is a genetic disorder characterized by cartilaginous defects, including nasal-maxillary cartilages.

Methods:  A retrospective series of 34 patients with Ehlers-Danlos syndrome and complaints of fatigue and poor sleep were evaluated by clinical history, physical examination, polysomnography (PSG), and, in some cases, anterior rhinomanometry. Additionally, a prospective clinical investigation of nine patients with Ehlers-Danlos syndrome was performed in a specialized Ehlers-Danlos syndrome clinic.

Results:  All patients with Ehlers-Danlos syndrome evaluated had SDB on PSG. In addition to apneas and hypopneas, SDB included flow limitation. With increasing age, flow limitation decreased in favor of apnea and hypopnea events, but clinical complaints were similar independent of the type of PSG finding. In the subgroup of patients who underwent nasal rhinomanometry, increased nasal resistance was increased relative to normative values. Nasal CPAP improved symptoms. Patients with Ehlers-Danlos syndrome presenting to the medical clinic had symptoms and clinical signs of SDB, but they were never referred for evaluation of SDB.

Conclusions:  In patients with Ehlers-Danlos syndrome, abnormal breathing during sleep is commonly unrecognized and is responsible for daytime fatigue and poor sleep. These patients are at particular risk for SDB because of genetically related cartilage defects that lead to the development of facial structures known to cause SDB. Ehlers-Danlos syndrome may be a genetic model for OSA because of abnormalities in oral-facial growth. Early recognition of SDB may allow treatment with orthodontics and myofacial reeducation.

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