FAMILIAL APNEA AND GASTROESOPHAGEAL REFLUX

Abstract

We studied 10 children (BWx̄3.5kg, 2.4-4.7kg; GAx̄39.9, 36-42 wk; 7f,3m) in 4 families with gastroesophageal reflux (GER) and recurrent apnea. All had sleep apnea with cyanosis leading to resuscitation (R) in 5, and vigorous stimulation (VS) in 5. They also had stridor, choking, obstructive apnea and cyanosis while awake leading to R(3) and VS (7). Symptoms of apnea began at a mean of 3.5 wk(2d-7.4 wk) and of GER at 5.2 wk(2d-26wk). Pneumograms documented an increase in periodic breathing (x̄9.0±6.8%) and/or prolonged apnea ≥ 16 sec. in 7/9 infants. GER was documented by Ba esophagram (6/9), pH probe (6/8) or endoscopy (3/6). Symptoms of GER resolved at 21 and 25 months in 2 with medical management (MM) including metaclopromide. Two infants (5 and 12 wk) are symptomatic on MM. Because of failure of MM, fundoplication (FP) was performed in 6 at a mean of 2.9 yr (1.0-8.8 yr). After FP, all continued to have sleep apnea requiring VS or R. In one, because of recurrence of awake stridor and obstructive apnea 4 years after FP, FP was repeated and obstructive apnea has not recurred in 10 mo. In one family, a female sibling with history of vomiting, apnea, cyanosis at 3 wk and frequent choking and spitting died of SIDS at 2 mo. In a second family, the father had a FP at 28 yr for severe GER. In summary, we have described familial apnea and GER in 10 children all of whom had awake stridor and obstructive apnea as symptoms of reflux. These symptoms were relieved by FP; however, significant sleep apnea persisted.

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