Effect of GH Therapy on Sleep-Related Breathing Disorders in Patients With Prader-Willi Syndrome

Treatment with growth hormone (GH) does not negatively influence sleep-related breathing disorders in young adults with Prader-Willi syndrome (PWS), according to study results published in The Journal of Clinical Endocrinology & Metabolism.

Sleep-related breathing disorders are associated with poor sleep quality and excessive daytime sleepiness. Previous studies have reported that breathing disorders related to sleep are common in patients with PWS. Central apneas and hypopneas are common in children with PWS and are the main cause for high apnea-hypopnea index (AHI) in this population. There are no studies regarding the effects of GH treatment compared with placebo on sleep-related breathing disorders in patients with PWS.

The aim of this study was to examine the effects of GH treatment compared with placebo on sleep-related breathing disorders in young adults with PWS who were treated with GH during childhood and had attained adult height.

The 2-year, randomized, double-blind, placebo-controlled, crossover study enrolled 27 young adult patients (mean age, 17.2 ± 1.8 years) with PWS. The participants were randomly assigned to receive 1 year of daily subcutaneous injections of 0.67 mg/m²/d GH or placebo, after which they switched to the alternative treatment for another year.  The main outcomes were AHI, obstructive apnea index, and central apnea index, measured by polysomnography.

Compared with placebo, 1 year of GH treatment did not increase AHI, central apnea index, or obstructive apnea index in young adults with PWS. In addition, after 2 years, no significant difference in these measurements was found between groups compared with baseline.

The recent guidelines to define obstructive sleep apnea in adults as an AHI of ≥5 events/h combined with typical complaints (daytime sleepiness, snoring, or witnessed apneas) or AHI ≥15 events/h regardless of complaints. According to these guidelines, 2 participants (7%) were diagnosed with obstructive sleep apnea, regardless of GH or placebo.

“[O]ur study shows that, compared to placebo, AHI does not significantly increase during GH treatment in young adults with PWS who were previously treated with GH during childhood,” concluded the researchers, adding that the results are “reassuring and prove that GH can be safely administered. However, clinical signs of [sleep-related breathing disorders] need to be monitored in children and adults with PWS….”

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Reference

Donze SH, de Weerd AW, van den Bossche RAS, Joosten KFM, Hokken-Koelega ACS. Sleep-related breathing disorders in young adults with Prader-Willi syndrome: a placebo-controlled, cross-over GH trial [published online April 18, 2019]. J Clin Endocrinol Metab. doi:10.1210/jc.2019-00391