ESPE Abstracts

Background: Patients with Prader-Willi-Syndrome (PWS) seem to be a risk-group for COVID-19 infection, due to their syndrome associated clinical features of hyperphagia and obesity, risk for central hypoventilation and obstructive sleep apnoea. Yet, little is known about the severity of infections and the long-term consequences in these patients. Therefore, we studied auxologic parameters and sleep laboratory examinations in PWS patients before and after COVID-19 infection.

Methods: 130 PWS patients were included in this study (mean age 10.8 years, range, 3.1-35.4). Of these, 83 participants (64%) had experienced a COVID-19 infection, and 73 caregivers answered our questionnaire. In 92/130 patients, polysomnographic data was available. In 57 patients with COVID-19 infection polysomnographic data were available before and after infection (35 female). Mean time between infection and post-COVID evaluation was 96.2 days (range, 5-402 days).

Results: None of our included patients had a severe course of COVID-19 infection and none were hospitalized. 6/73 (8.2%) had no symptoms, 56/73 (76.7%) mild symptoms, and 11/73 (15.1%) moderate symptoms. The control group of PWS patients without infection showed no differences in two adjacent polysomnographic evaluations. However, we found statistically significant differences in the COVID-19 group: statistically significant lower mean oxygen saturation (post 94.8% vs pre 95.7%, P=0.001), lower detected lowermost saturation (post 86.2% vs pre 87.3%, P=0.003), and a higher occurrence of hypopnea (post 13.9 vs 10.7, P=0.035). Moreover, we found a statistically significant reduction of time in optimal saturation range 95-100% (post 54.3% vs pre 73.8%, P=0.001), an increase in time in suboptimal saturation range 90-95% (post 45.5% vs 25.8%, P=0.001), and an increase in time in poor saturation range <90% (post 0.7% vs pre 0.2%, P=0.030). BMI-SDS for PWS showed no differences between the groups at any time. When applied, BMI-SDS for healthy German children was statistically significantly higher in the COVID group at follow-up after infection (post 0.56 vs pre 0.40, P=0.014). However, differences in BMI-SDS showed no influence on differences in polysomnographic evaluations in regression analyses.

Conclusion: PWS patients predominantly experienced mild symptoms during COVID-19 infection and none of them were hospitalized. However, on average three months after infection, differences in polysomnographic evaluations are still apparent, manifesting in lower oxygen saturations and more frequent hypopnoea. The infection caused weight-gain in the COVID-19-group, but this had no effect in regression analyses, ruling out an increased BMI-SDS as the cause. It remains unclear what mechanism caused this deterioration and if it will be persisting.