Sleep Breathing Disorders Appear Common for Patients with Duchenne Muscular Dystrophy

Ahmed Bamaga, MD

A recent Saudi Arabian-based sleep study showed that patients with Duchenne muscular dystrophy (DMD) commonly experience sleep-related disorders such as obstructive sleep apnea (OSA).¹ The data from the questionnaire showed that 29% of patients (n = 14) reported snoring more than half of the time and only 50% of those patients snored all the time (n = 7).

Of the total number of patients with DMD (n = 50), 13% reported having early morning headaches while 16% of patients reported having daytime sleepiness. Although there have been several studies that have assessed the sleep quality in DMD, there have been only a few conducted in Saudi Arabia.

Presented as a poster at the 2022 American Association of Neuromuscular & Electrodiagnostic Medicine Annual Meeting, held September 21-24, in Nashville, Tennessee, study investigator Ahmed Bamaga, MD, pediatric neurologist and assistant professor, King Abdulaziz University, and colleagues reported that none of the patients that participated in the study experienced breathing cessation during sleep, although 12% had occasional shortness of breathing.

The most common reported symptom was snoring among the patients with DMD. Thirty-two percent of patients (n = 16) had a score of more than 30% on the Pediatric Sleep Questionnaire which is associated with increased likelihood of OSA. In addition, patients on a steroid treatment reported higher scores on the questionnaire.

The study focused on investigating sleep quality in boys and teenagers with DMD at King Abdulaziz University Hospital. The investigation was handled through a retrospective record review which was cross-sectional and used a previously validated pediatric sleep quality questionnaire. The parents of the patients with DMD were contacted for recruitment of the study and then the researchers used the pre-validated pediatric sleep quality questionnaires on the patients. The mean age of the patients with DMD was 9 years with a range of 3 to 17 years of age while 29% of all patients have a body mass index that was more than 30.

Bamaga and colleagues noted that patients with DMD are at high risk of developing sleep breathing disorders, including obstructive sleep apnea and sleep-related hypoventilation, and based on these results, it appears that sleep related disorders are relatively common in DMD. They noted that further sleep studies should be part of the standard care of patients with DMD.

In addition to the elevated risk of developing sleep breathing disorders, the population of patients with DMD are also at risk for sleep disorders that are common in children and adolescents—who make up the majority of patients with DMD²—can be related to particular behaviors, whereas others may be caused by neurological or other medical conditions.

Considered a pillar of health, the importance of sleep among younger individuals cannot go understated, Carol Rosen, MD, professor of pediatrics, Case Western University, told NeurologyLive® in a recent interview.

Rosen discussed the issues with rushing a sleep cycle, the advice she’s given to parents, and whether sleep disorders can be exasperated by the long hours of the summer. “Figure out what the schedule is, how much sleep your child needs, and kind of work backwards. Maybe go back in 15 minute- or 30-minute increments, starting with your wakeup time. Move that back,” she suggested.

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REFERENCES

1. Bamaga A, Abuzinadah A, Alqarni L. Sleep Quality in Patients with Duchenne Muscular Dystrophy: A Questionnaire-Based Study. Presented at: AANEM 2022; September 21-24; Nashville, TN. Abstract 152.
2. Broomfield J, Hill M, Guglieri M, Crowther M, Abrams K. Life Expectancy in Duchenne Muscular Dystrophy: Reproduced Individual Patient Data Meta-analysis. Neurology. 2021;97(23): e2304-e2314. doi:10.1212/WNL.0000000000012910