Me hylphenida e imp o es paedia ic obs uc i e sleep apnoea
Me hylphenida e is a dopamine no epineph ine eup ake inhibi o used in ADHD and
na colepsy. We epo a case o a child wi h Wol am synd ome who had na colepsy and
obs uc i e sleep apnoea. We used me hylphenida e, which imp o ed he na colepsy as well
as obs uc i e sleep apnoea.
Case epo
We had ea lie epo ed a case o a 10-yea -old child wi h Wol am synd ome wi h obsessi e-
compulsi e diso de and na colepsy.1 She was on insulin, elmisa an, spi onolac one,
desmop essin, and flu oxamine. He polysomnog aphy showed an apnoea-hypopnea index
(AHI) o 18.5, indica ing se e e obs uc i e sleep apnoea. He sno e index was 21.9, oxygen
desa u a ion index was 10.1, baseline oxygen sa u a ion was 97.4%, and he minimum oxygen
sa u a ion was 84%. An ENT e alua ion did no e eal any adenoid o onsilla hype ophy o
o he abno mali ies in he o opha ynx. He pa en s exp essed eluc ance owa ds non-in asi e
en ila ion. We s a ed he on me hylphenida e 10mg p ima ily o na colepsy. He day ime
sleepiness and espi a o y dis ess educed conside ably. We pe o med a epea
polysomnog aphy a e wo yea s. He AHI index had educed om 18.5 o 4.4, desa u a ion
index educed o 4.8, sno e index became 1.4, baseline oxygen sa u a ion imp o ed o 98.3%,
and minimum oxygen sa u a ion inc eased o 86%.
Discussion
Obs uc i e sleep apnoea in Wol am synd ome may be due o he incoo dina ion o uppe
ai way muscles a ising om b ains em degene a ion.2 Neu opa hy due o diabe es may also
aec he pha yngeal and genioglossal muscle one, inc easing he isk o sleep apnoea in his
diso de .2 The no mal decline o no epineph ine in sleep causes excessi e loss o one o
genioglossus and pha yngeal muscles, esul ing in sleep apnoea3 in hese pa ien s.
Me hylphenida e is known o educe he eup ake o no epineph ine om he synapses, hus
inc easing i s concen a ion.4 This inc ease in no epineph ine may inc ease he one o he
genioglossus and pha yngeal muscles du ing sleep, opening up he ai way and educing sleep
apnoea. In addi ion o educing he AHI index, he d ug also imp o ed oxygen sa u a ion le els
and educed sno ing e en s.
S imulan s a e used in obs uc i e sleep apnoea o educe day ime sleepiness. A omoxe ine in
combina ion wi h oxybu ynin was ound o educe sleep apnoea se e i y in a clinical ial.5 This
epo shows ha s imulan s like me hylphenida e may also help in imp o ing obs uc i e sleep
apnoea. This may be especially impo an in adul s, whe e educed one o o opha yngeal
muscles is he p ima y cause o sleep apnoea.
Re e ence
1.Ra ind en RK, Vee il RT, A himannil S, Bala am N, Veedu PT, Vee il SA, Ayoo AK, Ma hew S,
Padinha a h K, Balan S. Sequen ial p esen a ion o obsessi e-compulsi e diso de and
na colepsy in a 10-yea -old gi l wi h Wol am synd ome 1. The Jou nal o Ne ous and Men al
Disease. 2024 Jul 1;212(7):403-5.
2.Licis A, Da is G, Eisens ein SA, Luga HM, He shey T. Sleep dis u bances in Wol am
synd ome. O phane Jou nal o Ra e Diseases. 2019 Aug 2;14(1):188.
3.Fenik VB, Da ies RO, Kubin L. REM sleep–like a onia o hypoglossal (XII) mo oneu ons is
caused by loss o no ad ene gic and se o one gic inpu s. Ame ican jou nal o espi a o y and
c i ical ca e medicine. 2005 No 15;172(10):1322-30.
4.Challman TD, Lipsky JJ. Me hylphenida e: i s pha macology and uses. In Mayo Clinic
P oceedings 2000 Jul 1 (Vol. 75, No. 7, pp. 711-721). Else ie .
5.Ta an o-Mon emu o L, Messineo L, Sands SA, Aza ba zin A, Ma ques M, Edwa ds BA, Ecke
DJ, Whi e DP, Wellman A. The combina ion o a omoxe ine and oxybu ynin g ea ly educes
obs uc i e sleep apnea se e i y. A andomized, placebo-con olled, double-blind c osso e
ial. Ame ican jou nal o espi a o y and c i ical ca e medicine. 2019 May 15;199(10):1267-76.
Funding None
Po en ial conflic o In e es None
