Auto-adjusting positive airway pressure in children with sickle cell anemia: results of a phase I randomized controlled trial

Marshall, Melanie; Bucks, Romola S.; Hogan, Alexandra M.; Hambleton, Ian; Height, Sue; Dick, Moira; Kirkham, Fenella J.; Rees, David C.

doi:10.3324/haematol.2008.005215

Cited by 52 publications

(57 citation statements)

References 26 publications

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“…The ultimate goal of our future work is to investigate a potential age-related association between oxygen desaturation, LV hypertrophy with diastolic dysfunction, pulmonary hypertension, and SCD-related morbidity, as this may be a target for therapy. 55 In conclusion, our data provide significant evidence to support the relationship of both asleep and waking oxygen desaturation with increased LV mass and LV diastolic dysfunction in SCD. In addition, we found a link between LV dimension and sleep abnormalities.…”

Section: Discussionsupporting

confidence: 63%

Left ventricular hypertrophy and diastolic dysfunction in children with sickle cell disease are related to asleep and waking oxygen desaturation

Johnson

Kirkham²,

Redline

et al. 2010

Blood

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Premature death and cardiac abnormalities are described in individuals with sickle cell disease (SCD), but the mechanisms are not well characterized. We tested the hypothesis that cardiac abnormalities in children with SCD are related to sleep-disordered breathing. We enrolled 44 children with SCD (mean age, 10.1 years; range, 4-18 years) in an observational study. Standard and tissue Doppler echocardiography, waking oxygen saturation averaged over 5 minutes, and overnight polysomnography were obtained in participants, each within 7 days. Eccentric left ventricular (LV) hypertrophy was present in 46% of our cohort. After multivariable adjustment, LV mass index was inversely related to average asleep and waking oxygen saturation. For every 1% drop in the average asleep oxygen saturation, there was a 2.1 g/m 2.7 increase in LV mass index. LV diastolic dysfunction, as measured by the E/E ratio, was present in our subjects and was also associated with low oxygen saturation (sleep or waking). Elevated tricuspid regurgitant velocity (> 2.5 m/sec), a measure of pulmonary hypertension, was not predicted by either oxygen saturation or sleep variables with multivariable logistic regression analysis. These data provide evidence that low asleep and waking oxygen saturations are associated with LV abnormalities in children with SCD. (Blood. 2010;116(1):16-21)

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Section: Discussionsupporting

confidence: 63%

Left ventricular hypertrophy and diastolic dysfunction in children with sickle cell disease are related to asleep and waking oxygen desaturation

Johnson

Kirkham²,

Redline

et al. 2010

Blood

View full text Add to dashboard Cite

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“…It may also be important to study the growth, neuropsychological and other organ functions in children as T & A may prevent some of the organ damage induced by chronic hypoxemia. Marshall et al 19 has shown that non operative management of OSA, by auto adjusting positive airway pressure in children with sickle cell disease, can improve hypoxemia. Role and timing of T & A, Hydroxyurea, chronic transfusions, and bone marrow transplantation in prevention of OSA and other long term complications also need to be evaluated prospectively in a randomized fashion.…”

Section: Resultsmentioning

confidence: 98%

Tonsillectomy and Adenoidectomy For Obstructive Sleep Apnea in Sickle Cell Anemia

2010

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“…Another study of autoPAP investigated the use of autoPAP in the home for 6 weeks in 12 children with sickle-cell anemia, which again found that autoPAP was effective and well tolerated. 7 Neither of these studies compared the autoPAP pressures to the gold standard manually titrated pressure utilizing experienced sleep technologists, and so our current study contributes to knowledge of the role of autoPAP in current pediatric practice.…”

Section: Discussionmentioning

confidence: 99%

“…7 Improvements in sleep-disordered breathing were documented between baseline and titration PSG, and no adverse effects were reported by children using the autoPAP at home. Neither of these studies compared the autoPAP pressure to the gold standard manually titrated pressure, utilizing experienced sleep technologists.…”

Section: Brief Summarymentioning

confidence: 99%

Autotitrating CPAP as a Tool for CPAP Initiation for Children

Mihai

Vandeleur

Pecoraro

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Few studies have assessed autotitrating positive airway pressure (autoPAP) for treatment of obstructive sleep apnea (OSA) in children. We aimed to review our use of autoPAP for initiation of continuous positive airway pressure (CPAP) therapy in children, and compare autoPAP-derived treatment pressures to CPAP treatment pressure determined by attended polysomnography (PSG). Methods: Retrospective review of children initiated on autoPAP from 2013 to 2015. Mean autoPAP pressure (AutoMean pressure) and average device pressure ≤ 90% of time (Auto90 pressure) were taken from downloaded data and compared to the recommended treatment pressure following titration PSG (PSG pressure). Results: Fifty-two children started CPAP, of whom 26 (age ± standard deviation 11.9 ± 3.4 years) used autoPAP and had titration PSG. AutoPAP was used on average 84% of nights (standard deviation 20%) in the first month, with a mean ± standard deviation 6.3 ± 2.0 hours of use on nights used. The median (interquartile range) obstructive apnea-hypopnea index decreased from 16.6 (11, 35) events/h before treatment to 2.2 (0.4, 3.8) events/h on the titration PSG. Median (interquartile range) PSG pressure was 9.0 cm H2O (7.0, 10.0), AutoMean pressure was 6.3 cm H2O (5.3, 7.5), and Auto90 pressure was 8.1 cm H2O (7.1, 9.5). These were significantly different (P < .001), with the significant difference lying between AutoMean and the other two pressures. PSG pressure was greater than or equal to the AutoMean pressure in all cases, and greater than or equal to the Auto90 pressure in 20 out of 26 cases (77%). Conclusions: AutoPAP is a safe and effective means of initiating CPAP in children. AutoMean and Auto90 pressures are usually below treatment pressure determined by titration PSG.

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Auto-adjusting positive airway pressure in children with sickle cell anemia: results of a phase I randomized controlled trial

Cited by 52 publications

References 26 publications

Left ventricular hypertrophy and diastolic dysfunction in children with sickle cell disease are related to asleep and waking oxygen desaturation

Left ventricular hypertrophy and diastolic dysfunction in children with sickle cell disease are related to asleep and waking oxygen desaturation

Tonsillectomy and Adenoidectomy For Obstructive Sleep Apnea in Sickle Cell Anemia

Autotitrating CPAP as a Tool for CPAP Initiation for Children

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