Abstract Introduction In-utero opioid exposure and its implications on the developing brain continue to be an important area of evolving sleep research. There has been a substantial increase in the use of synthetic opioids, specifically fentanyl, since 2013. A novel syndrome in children with fetal fentanyl exposure was recently described, termed Fetal Fentanyl Syndrome (FFS), including features of small for gestational age, microcephaly, distinctive facial features, cleft palate, and other limb and genital abnormalities. Specific facial features may increase the risk of obstructive sleep apnea in these children. Additionally, mice models demonstrate changes in sleep architecture and wake periods with decreased NREM and increased REM sleep after fentanyl exposure. This IRB-approved case series describes clinical characteristics, polysomnography results, and treatment of 4 children with FFS and sleep concerns at a large tertiary care center in Delaware, a state where the rate of neonatal abstinence syndrome is consistently above the national average. Report of case(s) Four patients, (2-3 years old, 75% male) with FFS completed sleep medicine evaluation and polysomnogram. All patients reported baseline snoring; three reported apnea and gasping during sleep, and one was noted to have mouth-breathing. Common anatomical features were short or prominent nasal tips, low nasal bridges, and abnormal chin positioning with micrognathia or retrognathia. One patient was noted to have repaired cleft palate. 100% of PSG studies were positive for obstructive sleep apnea with AHI ranging 2.9 to 43 events/hr. One patient was recommended to start low flow supplemental oxygen support; the other patients were referred for otolaryngology evaluation. All four patients spent less than 20% total sleep time (TST) in REM sleep, ranging from 10.6% to 18.3%. Conclusion This case series highlights the importance of obtaining a thorough sleep history and maintaining high clinical suspicion of sleep apnea in patients with FFS, particularly patients with predisposing facial features. Future research focusing on the physiologic pathways affected by FFS and further investigation into PSG findings may improve screening and clinical care in this population. Support (if any)
Cho et al. (Fri,) studied this question.