Twenty-five children, age range 2 to 14 years (mean age = 7), were referred to the Stanford University Sleep Disorders Clinic for various clinical symptoms, including excessive daytime somnolence, heavy nocturnal snoring, and abnormal daytime behavior. All children (10 girls and 15 boys) were polygraphically monitored during sleep. No sleep apnea syndrome or oxygen desaturation was revealed. However, each child presented significant respiratory resistive load during sleep associated with electrocardiographic R-R interval and endoesophageal pressure swings. The most laborious breathing occurred during REM sleep. Second degree atrioventricular blocks were also noted. Tonsillectomy and/or adenoidectomy was performed in every case and resulted in a complete disappearance or substantial amelioration of the reported symptoms. Objective evaluation by Multiple Sleep Latency Test and Wilkinson Addition Test confirmed the beneficial effect of surgery.
Although industrial exposure to n-hexane is known to cause neuropathy, it is less well recognized that inhalation of n-hexane present in the vapors of some commercial contact cements is also neurotoxic to peripheral nerves. A young man with a long history of addictive glue-sniffing developed severe distal symmetrical polyneuropathy several months after switching to a cement containing n-hexane and gradually improved several months after switching to another cement containing no n-hexane. Fascicular biopsy of radial cutaneous nerve showed striking segmental distention of axons by neurofilamentous masses with secondary thinning of myelin sheath, paranodal myelin retraction, and widening velocities were correspondingly slow. We conclude that n-hexane used as a solvent in some contact cements may be neurotoxic when inhaled to excess and, further, that the neuropathy has characteristic electrophysiological and pathological features.
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