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Congenital central hypoventilation

MedGen UID:
220902
Concept ID:
C1275808
Disease or Syndrome
Synonyms: Congenital Central Hypoventilation Syndrome; Congenital failure of autonomic control; Idiopathic congenital central alveolar hypoventilation; Primary alveolar hypoventilation
SNOMED CT: CCHS - Congenital central hypoventilation (399040002); Congenital pulmonary hypoventilation (399040002); Congenital central hypoventilation (399040002); Ondine curse (399040002)
 
Related genes: MYO1H, LBX1, PHOX2B
 
Monarch Initiative: MONDO:0800031
OMIM®: 209880
OMIM® Phenotypic series: PS209880

Disease characteristics

Excerpted from the GeneReview: Congenital Central Hypoventilation Syndrome
Congenital central hypoventilation syndrome (CCHS) represents the extreme manifestation of autonomic nervous system dysregulation (ANSD) with the hallmark of disordered respiratory control. The age of initial recognition of CCHS ranges from neonatal onset (i.e., in the first 30 days of life) to (less commonly) later onset (from 1 month to adulthood). Neonatal-onset CCHS is characterized by apparent hypoventilation with monotonous respiratory rates and shallow breathing either during sleep only or while awake as well as asleep; ANSD including decreased heart rate beat-to-beat variability and sinus pauses; altered temperature regulation; and altered pupillary response to light. Some children have altered development of neural crest-derived structures (i.e., Hirschsprung disease, altered esophageal motility/dysphagia, and severe constipation even in the absence of Hirschsprung disease) and/or tumors of neural crest origin (neuroblastoma, ganglioneuroma, and ganglioneuroblastoma). Neurocognitive delay is variable, and possibly influenced by cyanotic breath holding, prolonged sinus pauses, need for 24-hour/day artificial ventilation, and seizures. Later-onset CCHS is characterized by alveolar hypoventilation during sleep and attenuated manifestations of ANSD. [from GeneReviews]
Authors:
Debra E Weese-Mayer  |  Casey M Rand  |  Ilya Khaytin, et. al.   view full author information

Additional description

From MedlinePlus Genetics
Congenital central hypoventilation syndrome (CCHS) is a disorder that affects normal breathing. People with this disorder take shallow breaths (hypoventilate), especially during sleep, resulting in a shortage of oxygen and a buildup of carbon dioxide in the blood. Ordinarily, the part of the nervous system that controls involuntary body processes (autonomic nervous system) would react to such an imbalance by stimulating the individual to breathe more deeply or wake up. This nervous system reaction is impaired in people with CCHS. They must be supported with a machine to help them breathe (mechanical ventilation) or a device that stimulates a normal breathing pattern (diaphragm pacemaker). Some affected individuals need this support 24 hours a day, while others need it only at night.

Symptoms of CCHS usually become apparent shortly after birth when affected infants hypoventilate upon falling asleep. In these infants, a lack of oxygen in the blood often causes a bluish appearance of the skin or lips (cyanosis). In some milder cases, CCHS may not become apparent until later in life.

In addition to the breathing problem, people with CCHS may have difficulty regulating their heart rate and blood pressure, for example, in response to exercise or changes in body position. They also have decreased perception of pain, low body temperature, and occasional episodes of heavy sweating.

People with CCHS may have additional problems affecting the nervous system. About 20 percent of people with CCHS have abnormalities in the nerves that control the digestive tract (Hirschsprung disease), resulting in severe constipation, intestinal blockage, and enlargement of the colon. (Some researchers refer to the combination of CCHS and Hirschsprung disease as Haddad syndrome.) Some affected individuals develop learning difficulties or other neurological problems. People with CCHS are also at increased risk of developing certain tumors of the nervous system called neuroblastomas, ganglioneuromas, and ganglioneuroblastomas.

Additionally, individuals with CCHS usually have eye abnormalities, including a decreased response of the pupils to light. People with CCHS, especially children, may have a characteristic appearance with a short, wide, somewhat flattened face often described as "box-shaped."

In CCHS, life expectancy and the extent of any intellectual disabilities depend on the severity of the disorder, timing of the diagnosis, and the success of treatment.  https://medlineplus.gov/genetics/condition/congenital-central-hypoventilation-syndrome

Professional guidelines

PubMed

Trang H, Samuels M, Ceccherini I, Frerick M, Garcia-Teresa MA, Peters J, Schoeber J, Migdal M, Markstrom A, Ottonello G, Piumelli R, Estevao MH, Senecic-Cala I, Gnidovec-Strazisar B, Pfleger A, Porto-Abal R, Katz-Salamon M
Orphanet J Rare Dis 2020 Sep 21;15(1):252. doi: 10.1186/s13023-020-01460-2. PMID: 32958024Free PMC Article
Maloney MA, Kun SS, Keens TG, Perez IA
Expert Rev Respir Med 2018 Apr;12(4):283-292. Epub 2018 Feb 28 doi: 10.1080/17476348.2018.1445970. PMID: 29486608
Zaidi S, Gandhi J, Vatsia S, Smith NL, Khan SA
Auton Neurosci 2018 Mar;210:1-9. Epub 2017 Nov 13 doi: 10.1016/j.autneu.2017.11.003. PMID: 29249648

Recent clinical studies

Etiology

Ghelab Z, Bokov P, Teissier N, Micaelli D, Patout M, Hayotte A, Dauger S, Delclaux C, Dudoignon B
Pediatr Pulmonol 2023 Jun;58(6):1761-1767. Epub 2023 Apr 4 doi: 10.1002/ppul.26399. PMID: 37014159
Barbagelata E, Ambrosino I, Díaz DE Terán T, González M, Nicolini A, Banfi P, Ferraioli G, Solidoro P
Minerva Med 2023 Jun;114(3):372-378. Epub 2022 Oct 31 doi: 10.23736/S0026-4806.22.08261-1. PMID: 36315241
Chang GY, Salazar T, Karnwal A, Kun SS, Ellashek J, Shin CE, McComb JG, Keens TG, Perez IA
Sleep Breath 2023 May;27(2):505-510. Epub 2022 May 13 doi: 10.1007/s11325-022-02632-z. PMID: 35554785
Sunkonkit K, Chiang J, Moraes TJ, To W, Schneiderman JE, Cifra B, Amin R
Pediatr Pulmonol 2021 Jun;56(6):1694-1703. Epub 2021 Feb 1 doi: 10.1002/ppul.25278. PMID: 33524248
Gallego J
Compr Physiol 2012 Jul;2(3):2255-79. doi: 10.1002/cphy.c100037. PMID: 23723037

Diagnosis

Montalva L, Cheng LS, Kapur R, Langer JC, Berrebi D, Kyrklund K, Pakarinen M, de Blaauw I, Bonnard A, Gosain A
Nat Rev Dis Primers 2023 Oct 12;9(1):54. doi: 10.1038/s41572-023-00465-y. PMID: 37828049
Trang H, Samuels M, Ceccherini I, Frerick M, Garcia-Teresa MA, Peters J, Schoeber J, Migdal M, Markstrom A, Ottonello G, Piumelli R, Estevao MH, Senecic-Cala I, Gnidovec-Strazisar B, Pfleger A, Porto-Abal R, Katz-Salamon M
Orphanet J Rare Dis 2020 Sep 21;15(1):252. doi: 10.1186/s13023-020-01460-2. PMID: 32958024Free PMC Article
Maloney MA, Kun SS, Keens TG, Perez IA
Expert Rev Respir Med 2018 Apr;12(4):283-292. Epub 2018 Feb 28 doi: 10.1080/17476348.2018.1445970. PMID: 29486608
Ramanantsoa N, Gallego J
Respir Physiol Neurobiol 2013 Nov 1;189(2):272-9. Epub 2013 May 18 doi: 10.1016/j.resp.2013.05.018. PMID: 23692929
Hunt CE, Silvestri JM
Curr Opin Pulm Med 1997 Nov;3(6):445-8. doi: 10.1097/00063198-199711000-00011. PMID: 9391766

Therapy

Basu SM, Chung FF, AbdelHakim SF, Wong J
Anesth Analg 2017 Jan;124(1):169-178. doi: 10.1213/ANE.0000000000001470. PMID: 27918326
Abdunnur SV, Kim DH
Prog Neurol Surg 2015;29:64-75. Epub 2015 Sep 4 doi: 10.1159/000434657. PMID: 26393957
Straus C, Similowski T
Respir Physiol Neurobiol 2011 Sep 15;178(2):357-8. Epub 2011 Jul 23 doi: 10.1016/j.resp.2011.07.007. PMID: 21801857
Movahed MR, Jalili M, Kiciman N
Pacing Clin Electrophysiol 2005 Nov;28(11):1226-30. doi: 10.1111/j.1540-8159.2005.50194.x. PMID: 16359292
Klein DF
J Clin Psychiatry 1996;57 Suppl 6:21-7. PMID: 8647794

Prognosis

Chang GY, Salazar T, Karnwal A, Kun SS, Ellashek J, Shin CE, McComb JG, Keens TG, Perez IA
Sleep Breath 2023 May;27(2):505-510. Epub 2022 May 13 doi: 10.1007/s11325-022-02632-z. PMID: 35554785
Bardanzellu F, Pintus MC, Fanos V, Marcialis MA
Curr Pediatr Rev 2019;15(3):139-153. doi: 10.2174/1573396315666190621103954. PMID: 31223092
Maloney MA, Kun SS, Keens TG, Perez IA
Expert Rev Respir Med 2018 Apr;12(4):283-292. Epub 2018 Feb 28 doi: 10.1080/17476348.2018.1445970. PMID: 29486608
Perez IA, Keens TG
Respir Physiol Neurobiol 2013 Jan 1;185(1):186-93. Epub 2012 Oct 23 doi: 10.1016/j.resp.2012.10.008. PMID: 23099221
Healy F, Marcus CL
Paediatr Respir Rev 2011 Dec;12(4):253-63. Epub 2011 Apr 16 doi: 10.1016/j.prrv.2010.10.001. PMID: 22018041

Clinical prediction guides

Ghelab Z, Bokov P, Teissier N, Micaelli D, Patout M, Hayotte A, Dauger S, Delclaux C, Dudoignon B
Pediatr Pulmonol 2023 Jun;58(6):1761-1767. Epub 2023 Apr 4 doi: 10.1002/ppul.26399. PMID: 37014159
Finch CE, Leu RM, Harford KL, Westbrook AL, Kasi AS
J Clin Sleep Med 2023 Mar 1;19(3):549-554. doi: 10.5664/jcsm.10384. PMID: 36541215Free PMC Article
Welbel RZ, Rand CM, Zhou A, Fadl-Alla A, Chen ML, Weese-Mayer DE, Zelko FA
Pediatr Pulmonol 2022 Sep;57(9):2040-2047. Epub 2022 May 27 doi: 10.1002/ppul.25973. PMID: 35574731Free PMC Article
Trang H, Bourgeois P, Cheliout-Heraut F
Orphanet J Rare Dis 2020 Nov 17;15(1):322. doi: 10.1186/s13023-020-01601-7. PMID: 33203435Free PMC Article
Perez IA, Keens TG
Respir Physiol Neurobiol 2013 Jan 1;185(1):186-93. Epub 2012 Oct 23 doi: 10.1016/j.resp.2012.10.008. PMID: 23099221

Recent systematic reviews

Slattery SM, Perez IA, Ceccherini I, Chen ML, Kurek KC, Yap KL, Keens TG, Khaytin I, Ballard HA, Sokol EA, Mittal A, Rand CM, Weese-Mayer DE
Clin Auton Res 2023 Jun;33(3):231-249. Epub 2022 Nov 20 doi: 10.1007/s10286-022-00908-8. PMID: 36403185
Basu SM, Chung FF, AbdelHakim SF, Wong J
Anesth Analg 2017 Jan;124(1):169-178. doi: 10.1213/ANE.0000000000001470. PMID: 27918326

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