Respiratory Involvement in <i>HIST1H1E</i> ‐Related Rahman Syndrome: A Case of Severe Mixed Apnea
Bibliographic record
Abstract
Rahman syndrome (HIST1H1E-related neurodevelopmental syndrome, OMIM #617537) is a rare autosomal-dominant condition caused by truncating variants in the C-terminal domain of the HIST1H1E gene. It is characterized by macrocephaly, hypotonia, craniofacial anomalies, and multisystem anomalies. Although multisystem involvement has been increasingly described, respiratory manifestations remain sparsely documented. We report a female infant with mosaic HIST1H1E truncation (c.435dupC; p.Thr146Hisfs*50) who presented with severe mixed sleep apnea secondary to laryngomalacia, requiring two airway surgeries and multidisciplinary management. Despite surgical intervention, polysomnography demonstrated persistent mixed apneas, suggesting both structural and central components. Brain MRI revealed nonspecific ischemic changes that could contribute to the neurological phenotype. To contextualize this observation, we reviewed 70 published cases of Rahman syndrome. Respiratory involvement was reported in only 13.5% (neonatal respiratory distress), 2.8% (upper-airway anomalies), and 1.4% (sleep-disordered breathing), frequencies comparable to those in the general population, although most reports lacked systematic respiratory evaluation. These findings suggest that respiratory morbidity may be under-evaluated rather than absent in Rahman syndrome. The combination of hypotonia, craniofacial restriction, and possible brain-stem dysregulation provides a plausible pathophysiologic substrate for both central and obstructive apnea. We recommend considering airway assessment and polysomnography in affected individuals presenting with stridor, desaturations, or sleep-related breathing difficulties. This case further expands the phenotypic spectrum of HIST1H1E-related disorders and represents the first documented example of mosaicism associated with this condition.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".