The role of nasal CPAP in obstructive sleep apnoea syndrome due to mandibular hypoplasia

  1. Stanley D.W. MILLER1,3,*,
  2. Senan F. GLYNN1,
  3. John L. KIELY2,
  4. Walter T. McNICHOLAS1

Article first published online: 26 JAN 2010

DOI: 10.1111/j.1440-1843.2009.01681.x

Issue

Respirology

Respirology

Volume 15, Issue 2, pages 377–379, February 2010

Additional Information

How to Cite

MILLER, S. D., GLYNN, S. F., KIELY, J. L. and McNICHOLAS, W. T. (2010), The role of nasal CPAP in obstructive sleep apnoea syndrome due to mandibular hypoplasia. Respirology, 15: 377–379. doi: 10.1111/j.1440-1843.2009.01681.x

Author Information

  1. 1

    Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin,

  2. 2

    Our Lady of Lourdes Hospital, Drogheda, Ireland, and

  3. 3

    Department of Respiratory Medicine, St. James' University Hospital, Leeds, UK

*Stanley D.W. Miller, Department of Respiratory Medicine, St. James' University Hospital, Beckett Street, Leeds LS9 7TF, UK. Email: stanley.miller@leedsth.nhs.uk

Publication History

  1. Issue published online: 26 JAN 2010
  2. Article first published online: 26 JAN 2010
  3. Received 20 October 2008; invited to revise 18 November 2008; revised 16 December 2008; accepted 19 December 2008 (Associate Editor: David Hui).

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Keywords:

  • continuous positive airway pressure;
  • hypoplasia;
  • mandible;
  • obstructive sleep apnoea syndrome;
  • treatment

ABSTRACT

Melnick Needles syndrome (MNS), Treacher Collins syndrome (TCS) and Pierre Robin syndrome (PRS) are congenital abnormalities with characteristic facial appearances that include micrognathia. A 20-year-old girl with MNS, a 16-year-old boy with TCS and a 12-year-old girl with PRS attended the sleep apnoea clinic at our institution at different times. Diagnostic sleep studies were initially performed on all three patients to confirm the diagnosis of obstructive sleep apnoea syndrome (OSAS). They subsequently commenced nasal CPAP (nCPAP) treatment and their progress was followed. A limited sleep study on the patient with MNS demonstrated moderate/severe OSAS with an AHI of 33 events/h. Commencement of nCPAP resulted in symptomatic improvement. Overnight oximetry in the patient with TCS showed repeated desaturation to SpO2 <90%. Subsequent treatment by nCPAP almost completely abolished the desaturation events. Overnight polysomnography in the patient with PRS demonstrated severe OSAS with an AHI of 49 events/h. After 3 years of nCPAP therapy, this patient requested discontinuation of treatment. Subsequent polysomnography without nCPAP revealed an AHI of <5 events/h. The use of nCPAP in the patients with MNS and TCS resulted in effective control of their sleep abnormalities. Mandibular growth and enlargement of the posterior airway space led to resolution of OSAS in the patient with PRS. There is a definite role for nCPAP therapy in patients with congenital micrognathia and OSAS. The use of nCPAP may obviate the need for more invasive corrective surgery for OSAS and is not necessarily a life-long requirement.

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